How to appeal a Medicare decision
You have the right to appeal. Many appeals succeed.
If Medicare or your plan denies a service, a drug or payment for care you've had, or ends care you think you still need, you can appeal. The process depends on whether you have Original Medicare, a Medicare Advantage plan or a Part D plan.
The five levels
- Level 1: redetermination by the company that handles claims (Original Medicare) or reconsideration by your plan.
- Level 2: review by an independent contractor.
- Level 3: a hearing before an Administrative Law Judge (a minimum dollar amount applies).
- Level 4: review by the Medicare Appeals Council.
- Level 5: federal court (a minimum dollar amount applies).
Where to start
- Original Medicare: follow the instructions on your Medicare Summary Notice. You generally have 120 days from receiving it to ask for a redetermination.
- Medicare Advantage: ask your plan for a reconsideration within the deadline in its denial notice (usually 65 days).
- Part D: ask your plan for a coverage determination or exception first, then appeal a denial within the deadline in its notice.
Fast appeals
If you think you're being discharged from a hospital too soon, or your skilled nursing, home health, hospice or rehab care is ending too soon, you can ask for a fast appeal from an independent reviewer. Follow the notice you're given; the deadlines are short, sometimes by midnight of the day before discharge.
If waiting for a standard decision could seriously harm your health, ask your plan for an expedited decision.
Tips
- Get a letter from your doctor explaining why the care is medically necessary.
- Keep copies of everything, and note dates and names of people you speak to.
- Ask your State Health Insurance Assistance Program for free help.
Common questions
No. There's no fee to file a Medicare appeal.
Yes. You can appoint a representative, such as a family member, friend or advocate.
Want help with your own choices?
Every state runs a State Health Insurance Assistance Program (SHIP) with trained counselors who give free, unbiased Medicare help and do not sell plans. Find yours on our Medicare by state pages, or call Medicare at 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048, 24 hours a day, 7 days a week).
Planning the rest of your coverage in retirement? We can help with life insurance later in life and final expense coverage.
General information about the federal Medicare program, not advice about your situation. Figures are for 2026 unless stated and change every year; last reviewed September 29, 2026. Quote My Policy is a private company. Not connected with or endorsed by the United States government or the federal Medicare program.
Quote My Policy does not sell Medicare plans on this site. For plan-specific help, contact Medicare at 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048, 24 hours a day, 7 days a week) or your State Health Insurance Assistance Program.