Your coverage
Medicare, Medicare Advantage and drug plans
Original Medicare, Medicare Advantage plans, Part D drug plans and Medigap.
Do this today
- Find the kind of plan you have Pick the closest match below. Each page has the appeal steps, deadlines and free help for it.
- Read: Fast appeals when a hospital or facility is ending your care 6 minute read. A hospital says you are being discharged, or a nursing facility, home health agency, rehabilitation facility or hospice says Medicare coverage is ending. You can ask for a fast review. Time of day matters.
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Put this step on My Plan
So you can come back to it, and keep your dates and calls in one place.
In brief
- For a hospital discharge, ask the Medicare quality reviewer no later than the day you are discharged. For ending nursing, home health, rehabilitation or hospice care, ask by noon of the day after you get the notice.
- The reviewer is a Beneficiary and Family Centered Care Quality Improvement Organization (QIO). The notice you were handed names it and gives the phone number. If you lost the notice, call 1-800-MEDICARE (1-800-633-4227).
- A timely request protects you from being billed for the extra days while the review runs. A late request is still reviewed, without that protection.
- Check the date and time on your notice, which controls.
Read the full guide: Fast appeals when a hospital or facility is ending your care
Coverage types in this group
Each page has the appeal steps, deadlines and free help for that coverage.
- Original Medicare (Parts A and B)
Medicare paid by the federal government, not a private plan. A denial arrives on a Medicare Summary Notice, with five levels of appeal. If a hospital stay, rehab or nursing care is ending, use the red box below: that clock is much shorter.
- Medicare Advantage (Part C)
Medicare run through a private plan. Appeal to the plan first, within 65 days of the date on its denial notice. If a hospital stay, rehab or nursing care is ending, use the red box below: that clock is much shorter.
- Medicare drug plan (Part D)
A prescription drug plan under Medicare. A drug denial starts with a coverage decision or an exception request. The independent review step is not automatic: you or your prescriber must ask for it in writing.
- 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.
More guides, tools and letters
More guides, tools, letters 18
Guides
- Fast appeals when a hospital or facility is ending your care
A hospital says you are being discharged, or a nursing facility, home health agency, rehabilitation facility or hospice says Medicare coverage is ending. You can ask for a fast review. Time of day matters.
- Medicare Advantage appeals
How to appeal when a Medicare Advantage plan refuses to approve or pay for care. Learn the 65-day deadline, the plan's decision times (including the 2026 prior authorization rule) and the automatic outside review.
- Medicare drug plan appeals and exceptions
What to do when a Medicare drug plan will not cover a prescription. Ask for a coverage decision or an exception, then appeal. The outside review step is not automatic.
- Medicare observation status
If a hospital admitted you and then changed you to observation, you may have a right to appeal that change, but only before you leave the hospital. Learn who qualifies, what notice to expect and what has closed.
- Original Medicare: the five appeal levels
A plain walk through the five levels of a Medicare Parts A and B appeal. It starts from the Medicare Summary Notice. It names the deadlines that trip people up and what to do first.
Tools
- Tool
Medicare appeal navigator
Find your level in the Medicare appeal process, the next level, the form and the time limit.
Letters and scripts
- Letter or script
Medicare Advantage reconsideration request
Ask your Medicare Advantage plan to review its denial again. The plan's appeal is called a reconsideration, and an outside reviewer sees the case if the plan says no.
- Letter or script
Medicare drug plan exception request
Ask your Medicare drug plan to cover a drug that is not on its list, or to charge a lower cost-sharing tier. Your prescriber must support the request.
- Letter or script
Medicare redetermination request
Ask the Medicare contractor to review again a decision on your Original Medicare claim. This is the first appeal, called a redetermination.
- Letter or script
Phone script: ask Medicare for a fast appeal when care is ending
What to say when you phone the Medicare quality reviewer to ask for a fast appeal because a hospital stay, nursing facility, rehabilitation or home health care is ending, and what to write down. For Original Medicare and Medicare Advantage.
Checklists
- Checklist
Medicare appeal
The notices to look for, the forms and the deadlines at each level of a Medicare appeal, including fast appeals for hospital discharge and ending services.
Denial reasons
- Denial reason
Care is ending
Hospital, rehab, nursing home or home health care ending? Medicare: call the reviewer on your notice by noon the day after you get it, or 1-800-MEDICARE (1-800-633-4227). Medicaid or job-based plan: see What to send.
Programs and services
- Program or service
1-800-MEDICARE: talk to a person about Medicare
The Medicare phone line and live chat, open all day every day. Staff can point you to the right step for a complaint, and can pass an unresolved complaint to the Medicare Beneficiary Ombudsman.
From Medicare (Centers for Medicare & Medicaid Services)
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy
- Program or service
Medicare Interactive: Medicare appeals
Free plain-language guides to appealing a Medicare denial, split by Original Medicare, Medicare Advantage and Part D drug coverage, from the Medicare Rights Center. Covers Medicare only.
From Medicare Rights Center
- Program or service
Medicare Rights Center national helpline
Free phone counseling for people with Medicare, their families and caregivers on benefits, denials and appeals, and cost-saving programs. Spanish is available. It covers Medicare only.
From Medicare Rights Center
- Program or service
Medicare.gov: filing an appeal
The official Medicare page on appealing a coverage or payment decision, with separate instructions for Original Medicare, Medicare health plans and drug plans, plus fast appeals when services end too soon.
From Medicare.gov (Centers for Medicare & Medicaid Services)
- Program or service
State Health Insurance Assistance Program locator (shiphelp.org)
The national site for finding your local State Health Insurance Assistance Program (SHIP), which gives free, one-on-one Medicare counseling, including help with complaints and appeals.
From SHIP National Technical Assistance Center
Questions to keep handy
- What exactly was denied, and under which part of the plan?
- What is my deadline, and what is it counted from?
- Where and how do I send my request, and how will I prove it arrived?
- Who decides, and can I ask for a faster decision?
Not what you need? Find a person who can help, or search the whole site.