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.
Reviewed by Joshua H. Pannell, Licensed Insurance Agent (SC license #400481) ·
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 comparing your options?
Currently we represent 41 organizations which offer 397 products in your area. You can always contact Medicare.gov or 1-800-MEDICARE for help with plan choices.
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.
Currently we represent 41 organizations which offer 397 products in your area. You can always contact Medicare.gov or 1-800-MEDICARE for help with plan choices.