How to appeal a Medicare denial

If Medicare or your plan refuses to pay for care, a drug or equipment, you have the right to appeal, and many appeals succeed. Start with the notice you received: it explains the decision and how to appeal.

Original Medicare: five levels

1. Redetermination by the company that handles Medicare claims. Ask within 120 days of getting your Medicare Summary Notice.
2. Reconsideration by a Qualified Independent Contractor, within 180 days of the first decision.
3. Hearing with an Administrative Law Judge, within 60 days. In 2026 the amount in dispute must be at least $200.
4. Review by the Medicare Appeals Council, within 60 days.
5. Federal district court, within 60 days. In 2026 the amount in dispute must be at least $1,960.

Medicare Advantage and Part D plans

Ask your plan to reconsider within 65 days of its decision (for drug plans, this is called a redetermination). If the plan says no again on a medical service, your case goes to an independent review organization automatically. After that, the later levels match Original Medicare's.

Fast appeals

If waiting could seriously harm your health, ask for an expedited decision; your doctor's support helps. Plans must generally decide fast appeals within 72 hours. If you think a hospital or nursing facility is discharging you too soon, you can ask your area's Beneficiary and Family Centered Care Quality Improvement Organization for a quick review; the number is on the notice the facility must give you.

Tips

• Ask your doctor for a letter explaining why you need the care.
• Keep copies of everything you send, and note dates and names from every call.
• Your SHIP can help you with an appeal for free.