Your rights
How to appeal a Medicare denial: steps and deadlines
A denial isn't final. Every "no" from Medicare or a Medicare plan comes with appeal rights, and the first step is free and done in writing or by phone. The most important thing is the deadline, which is shorter than many people expect.
Last reviewed October 26, 2026. General information, not advice about any plan.
Your first step, by type of coverage
- Original Medicare
- Your Medicare Summary Notice shows the denial and an "appeal by" date: 120 days from when you get it. Ask the company that handles Medicare claims to look again (a "redetermination"), following the notice's instructions or using form CMS-20027.
- Medicare Advantage
- Ask your plan to reconsider within 65 days of the date on its denial notice. It usually has 30 days to decide on care you haven't had yet, 60 days for a payment, 7 days for a Part B drug, or 72 hours for a fast appeal when waiting could seriously harm your health. If it still says no, your case goes to an independent reviewer automatically.
- Part D drug plan
- Ask the plan to look again within 65 days of the denial notice. It has 7 days for a drug, 14 days for a payment, or 72 hours for a fast appeal. You can also ask for an exception to cover a drug that isn't on its list, or at a lower cost; your prescriber must explain the medical reason. Unlike Medicare Advantage, if the plan says no again, you must ask the independent reviewer, within 60 days.
Missed a deadline? You can still ask, in writing, and explain the reason for the delay.
When care is ending: fast appeals
If you think care is ending too soon, an independent reviewer for your state (the BFCC-QIO, listed on your notice) can decide quickly.
- Leaving the hospital
- You'll get "An Important Message from Medicare about Your Rights." Call the reviewer no later than the day you're scheduled to leave. You can stay while they decide, generally without paying for those extra days.
- Skilled nursing, home health, hospice or outpatient rehab
- You'll get a "Notice of Medicare Non-Coverage" at least 2 days before services end. Call the reviewer by noon the day before the end date.
- Changed from inpatient to observation
- Since 2025, if the hospital changes your stay from inpatient to outpatient observation, you should get a Medicare Change of Status Notice and can appeal. It's best to do it while you're still in the hospital.
Medicare Advantage prior authorization
Since January 1, 2026, Medicare Advantage plans must decide prior authorization requests within 72 hours when urgent and 7 calendar days otherwise (drugs follow their own timelines), and a denial sent to your provider must give a specific reason. If the plan misses its deadline, that counts as a denial you can appeal. A plan decision made while you're already getting care can be appealed too.
If the first appeal fails
Appeals have five levels in all. After the plan or Medicare's contractor:
- An independent reviewer (automatic for Medicare Advantage; you ask for Original Medicare and Part D).
- A hearing with an administrative law judge, within 60 days, if at least $200 is in dispute.
- The Medicare Appeals Council, within 60 days.
- Federal court, within 60 days, if at least $1,960 is in dispute ($2,000 from 2027).
- Keep copies of every notice, letter and form, and write down who you spoke to and when.
Free help
- Your state's SHIP
- Free counselors who help with appeals. Your state's number is on its license-check page.
- 1-800-MEDICARE
- 1-800-633-4227 (TTY 1-877-486-2048). If a problem isn't resolved, ask for it to go to the Medicare Beneficiary Ombudsman.
- A representative
- A family member, friend or lawyer can handle your appeal with form CMS-1696 or a signed letter. It lasts a year.
- Your agent
- A good agent can help you read the notice and gather documents, though the appeal is yours to file.
Common questions
How long do I have to appeal a Medicare denial?
Original Medicare: 120 days from when you get your Medicare Summary Notice. Medicare Advantage and Part D: 65 days from the date on the plan's denial notice. Use the date printed on your notice.
What's the difference between an appeal and a grievance?
An appeal is for a "no" about coverage or payment. A grievance is a complaint about how you were treated, like poor service or long waits. A grievance doesn't change a coverage decision.
Can my doctor appeal for me?
For Medicare Advantage and Part D, your doctor can ask for a decision or a first appeal for you, including fast ones. For later levels, or to have a family member act for you, use an appointment of representative form or a signed letter.
Does it cost anything to appeal?
No. There's no fee to appeal. Later levels, like a hearing with a judge, require a minimum amount in dispute ($200 in 2026 and 2027).
Keep reading
- What Medicare covers for a hospital stay (and why "observation" matters)What Part A pays for a hospital stay, the 2026 deductible and daily costs, the difference between being an inpatient and "under observation," and the notices and appeal rights you have.
- Does Medicare cover nursing home care? Skilled nursing vs. long-term careMedicare covers short-term skilled nursing facility care after a qualifying hospital stay, up to 100 days, but not long-term nursing home care. The 3-day rule, 2026 costs, and what to do when coverage ends.
- SHIP counselor or Medicare agent: who should you call?Both help with Medicare for free, but they do different jobs. What a SHIP counselor does, what an agent does, and when to use each (or both).
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