How do I file an appeal?

What's an appeal?

An appeal is the action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan.

You have the right to appeal if Medicare, your Medicare health plan, or your Medicare drug plan denies one of these:

  • A request for a health care service, supply, item, or prescription drug that you think you should be able to get
  • A request for payment of a health care service, supply, item, or prescription drug you already got
  • A request to change the amount you must pay for a health care service, supply, item, or prescription drug

You can also appeal if Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or prescription drug you think you still need.

If you have a Medicare Medical Savings Account (MSA) Plan, you may appeal if you think you have met your deductible or you believe a service or item should count toward your deductible.

If you decide to appeal

If you decide to appeal, ask your doctor, health care provider, or supplier for any information that may help your case. See your plan materials, or contact your plan for details about your appeal rights.

The appeals process has 5 levels. If you disagree with the decision made at any level of the process, you can generally go to the next level. At each level, you'll be given instructions in the decision letter on how to move to the next level of appeal.