Coverage type · Medicare
Medicare Supplement (Medigap)
Private insurance that pays some costs Original Medicare leaves. Your state regulates it. A dispute usually starts with the insurer, then your state insurance department, not Medicare. We could not confirm that no federal appeal exists.
On this page 7
- Who has this
- People with Original Medicare who bought a private Medicare Supplement policy, called Medigap, to pay some of the costs Medicare leaves, such as deductibles and coinsurance.
- Who regulates it
- Your state insurance department. Medigap policies are standardized under federal law and regulated by the states. A policy may be sold only if the state's program applies the federal minimum standards, or the federal Secretary has certified the policy.
- Can your state help?
- Yes. Your state insurance department regulates Medigap and takes complaints about it. Your state page lists the department and the state's State Health Insurance Assistance Program. Find your state.
How to tell this is your coverage
- You have a separate private policy that pays after Original Medicare pays its share. Medicare pays first, then the Medigap policy pays its share.
- In most Medigap policies the insurer receives Part B claim information directly from Medicare.
- The policy cannot be used to pay Medicare Advantage copayments, deductibles or premiums. If you have a Medicare Advantage plan, this page is not about your plan.
The appeal steps, in order
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Ask your Medigap insurer to review
Official name: The insurer's own complaint or claim review process
- Who decides
- Your Medigap insurer
- Your deadline
- Set by your policy and your state, not by federal Medicare appeal rules. The rules we use give no number. Find the time limit in the denial letter and your policy, and check the date on your notice, which controls.
- Their deadline
- Set by your policy and your state. The rules we use give no number. Ask the insurer for its decision date in writing.
- What to send
- Your Medigap denial letter, your Medicare Summary Notice for the same service, and a short written request that the insurer review its decision. Say what you think it owes you and why.
- If you lose, or hear nothing
- First check who denied the claim. If Medicare itself denied the underlying claim, the route is the Original Medicare appeal, because Medigap generally pays only when Medicare pays. If Medicare paid and your Medigap insurer did not pay its share, ask the insurer for a review, then complain to your state insurance department. We could not confirm in a primary source that no federal Medicare appeal exists for a Medigap insurer's own claim decision, so confirm this with your state insurance department or a State Health Insurance Assistance Program counselor.
- The rule
- 42 U.S.C. 1395ss, Medicare supplemental policies
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Complain to your state insurance department
- Who decides
- Your state insurance department
- Your deadline
- Set by your state. Look on your state page and ask the department. Check the date on your notice, which controls.
- Their deadline
- Set by your state. Ask the department for its usual response time.
- What to send
- A written complaint with your Medigap policy, the insurer's denial and any correspondence, and your Medicare Summary Notice for the same service.
- If you lose, or hear nothing
- If the department cannot resolve it, ask the department or free legal aid what options remain for your policy and your state.
- The rule
- 42 U.S.C. 1395ss, state regulation of Medigap
If waiting could harm your health
We found no fast appeal of its own for Medigap; ask the insurer and your state insurance department. If the problem is that Medicare is stopping or denying the care itself, such as a hospital discharge, the end of skilled nursing, home health or hospice care, or a change to observation status, use the fast appeal routes described on the Original Medicare page and act within their deadlines, which can be hours. Check the date and time on your notice, which controls.
Free help for this coverage
- State Health Insurance Assistance Program (SHIP)
Free one-on-one Medicare counseling that is not connected to any insurance company. Find your local program at shiphelp.org or by calling 877-839-2675. Your state page lists your state's program.
- Your state insurance department
Regulates Medigap policies and takes complaints. Your state page lists the department and how to reach it.
- 1-800-MEDICARE
Call 1-800-633-4227 (text telephone 1-877-486-2048) for help with the underlying Medicare claim.
- Medicare Rights Center helpline
A national nonprofit. Free helpline 800-333-4114, Monday to Friday (as listed in November 2026); Spanish is available by pressing 8. Help is by phone only, and the organization asks you not to send personal Medicare information online.
- Legal aid
Free civil legal help for people with low incomes. A program can advise you on a dispute, but it cannot take every case. Your state page lists legal aid programs for your state.
Who this covers
This page is for people who have a Medicare Supplement policy, called Medigap, alongside Original Medicare. It covers disputes with the Medigap insurer over its own payment. If Medicare itself denied your claim, see Original Medicare. If you have a Medicare Advantage plan, see Medicare Advantage; a Medigap policy cannot pay Medicare Advantage costs.
How to tell this is your coverage
You have a private policy that pays after Medicare pays. If Medicare paid and your Medigap insurer did not pay its share, your dispute is with the insurer. If Medicare denied the claim, your dispute starts with Medicare.
What does not apply to you
We found no five federal Medicare appeal levels for the insurer’s own decision. Medigap policies are private insurance standardized under federal law and regulated by the states. The forms and deadlines for Original Medicare appeals apply only to the underlying Medicare claim.
We could not confirm in a primary source that Medicare has no appeal for a Medigap insurer’s decision. This is based on the fact that the federal appeal rules cover Medicare’s own decisions only. Confirm it with your state insurance department or a State Health Insurance Assistance Program counselor before you rely on it.
Where people go wrong
- Appealing a Medigap decision to Medicare. The Medicare appeal levels are written for Medicare’s own decisions. If Medicare paid and your Medigap insurer did not, start with the insurer and your state insurance department.
- Skipping the Medicare appeal when Medicare denied. Medigap generally pays only when Medicare pays. If Medicare denied the claim, the way to fix it is usually the Original Medicare appeal, with its 120-day first deadline.
- Missing the insurer’s own time limit. The limit comes from your policy and your state, not from Medicare. Read your policy and the insurer’s letter, and ask your state insurance department or your State Health Insurance Assistance Program.
- Not telling the regulator. Your state insurance department regulates Medigap policies and can take a complaint if the insurer’s review does not fix the problem.
Free help is listed above.
Sources
- Medicare.gov, how Medigap works
- 42 U.S.C. 1395ss, Medicare supplemental policies (Social Security Act section 1882)
- 42 CFR Part 405, Subpart I, determinations, redeterminations, reconsiderations and appeals under Original Medicare
- Administration for Community Living, State Health Insurance Assistance Program