A Medicare appeal is a formal request to review a decision about your Medicare coverage or payment. You can appeal if Medicare or your Medicare Advantage/Part D plan denies coverage for a service or drug. There are five levels of appeal: redetermination, reconsideration, ALJ hearing, Medicare Appeals Council, and federal court.
Key Points
- Five levels of Medicare appeal: redetermination, reconsideration, ALJ hearing, Medicare Appeals Council, federal court
- File an appeal if Medicare denies coverage for a service or drug
- Deadlines: typically 60-120 days from the denial notice
- An independent agent can help you understand your appeal rights
- Medicare Rights Center: free help with Medicare appeals