Medicare and Your Private Medical Information

Published by: Medicare Made Clear

Medicare is required by law to protect your personal medical information. There are some situations when Medicare is allowed to disclose or use this information though.



Operating your Medicare coverage and paying for health care costs


Medicare does have the right to use your information though when it relates to operating your Medicare coverage and to pay for your health care services and supplies. In this situation, your information may be used to help provide you with customer service, resolve your complaints you may have filed and ensure you are getting quality care.


Medicare can disclose your information to process payment of your medical claims for health care services received, to collect your premiums, and to prepare your Medicare Summary Notice. (This is a letter people with Original Medicare (Parts A & B) get every three months in the mail to notify them of the services and supplies that their providers have billed Medicare for during the 3-month period, what Medicare paid and the maximum amount a person may owe the provider.)1



Who Medicare can disclose your information to


However, under certain circumstances, Medicare is also allowed to disclose your personal medical information for purposes other than to pay or process your medical claim.


In certain situations, Medicare may disclose your information to:


  • To you or the person you have designated to act on your behalf;
  • To the Secretary of the Department of Health and Human Services; and
  • When required by law.



Other situations where Medicare can use your personal information


Under limited circumstances, Medicare can also use or disclose your personal medical information for other reasons not directly related to your personal Medical health.


Some of these circumstances include using your information to help investigate and report disease outbreaks, assist in fraud investigations, for law enforcement purposes, for select research studies, to contact you about new or changed Medicare benefits, to comply with court orders and care coordination and qualify improvement purposes.



When Medicare may not use your personal information


Medicare is not allowed to use or disclose your personal medical information for purposes other than what is outlined in the Notice of Privacy Practices for Original Medicare, unless you have given written permission. You may revoke your written permission at any time.


If you have further questions about your privacy rights as Medicare beneficiary, please contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact your Medicare plan provider if you have a private Medicare plan.



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