# How to Appeal a Medicare Coverage Decision > **Summary:** Find the right Medicare appeal pathway, gather supporting information, and understand when to ask for a fast review. > **Publisher:** InsuraFAQ > **Author:** InsuraFAQ Editorial Team > **Published:** 2026-11-07 > **Canonical URL:** https://insurafaq.com/insurance/medicare-appeals/ > **Tags:** medicare, claims, health If you disagree with a Medicare coverage or payment decision, you can ask for an appeal. Start with your notice and identify whether the decision involves Original Medicare, a Medicare health plan, or a Medicare drug plan: the first steps and deadlines differ. Follow the instructions on your own notice promptly and ask your provider for information supporting your case. [Medicare explains the separate appeal pathways](https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals). An appeal can address a refusal to cover or pay for an item, service, supply, or drug, a disputed amount you must pay, or coverage ending when you believe it is still needed. An appeal is not a guarantee of payment or continued coverage. If you are unsure which process applies, contact Medicare or your plan and ask for the written instructions. ## First, find the decision and your deadline Keep the notice or decision letter. Identify the item or service, relevant dates, why coverage or payment was denied, the organization to contact, and the deadline for the next step. Your plan membership card usually has its contact information. If you have not received a written decision or cannot find the instructions, ask Medicare or the plan how to obtain them. Do not assume a deadline for one kind of coverage applies to another. Ask your doctor, prescriber, provider, or supplier for records or a statement that may support the appeal. Keep copies of your submission and supporting documents, note when and how you sent them, and protect your Medicare number and other personal information. If a trusted person will act for you, inquire about appointing a representative. ## Original Medicare: start with your summary notice For Original Medicare, the first appeal is a **redetermination**. Look at your Medicare Summary Notice (MSN), which gives the filing date and instructions. Medicare describes several filing options, including a redetermination request form, following the MSN instructions, or a written request to the Medicare Administrative Contractor. Identify the item or service and explain why you disagree; include relevant supporting information. Use the address and instructions in the notice. [Review Medicare's Original Medicare appeal instructions](https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/original-medicare). If you miss the deadline, Medicare says you may still file and receive a decision if you show good cause for the delay. Explain the circumstances instead of assuming a late appeal is automatically accepted. ## Medicare Advantage and other health plans For a Medicare Advantage service or supply decision, contact the plan for an **organization determination** if you need a coverage decision. If you disagree with an initial denial, follow the plan's notice and materials to request a first-level **reconsideration**. Your provider may be able to help; Medicare explains who may request a review and when a fast appeal may be appropriate. For some other Medicare health plans, including PACE and Medicare Cost plans, different rules can apply. Check [Medicare's health-plan guidance](https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/medicare-health-plans) and your plan's written information. If waiting for a standard decision could seriously harm your health, ask the plan about an expedited appeal and discuss it with your provider. This is different from the fast review of a discharge or services ending described below. ## Medicare drug plans For a drug coverage decision, contact your drug plan about a **coverage determination** or, where appropriate, an exception. The process can differ depending on whether you are requesting a drug or reimbursement for one already purchased. Your prescriber may need to provide supporting information. If you disagree with the initial decision, follow the denial notice and plan materials to request a first-level **redetermination**. See [Medicare's drug-plan appeal instructions](https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/drug-plans). Ask the plan and your prescriber about an expedited request if waiting could seriously jeopardize your health. Keep the drug name, decision notice, and supporting statement together so you can follow the correct process. ## When covered care is ending too soon You may have a right to a **fast appeal** if you believe Medicare-covered services are ending too soon or you are being discharged too soon from a hospital, skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility, or hospice. Your provider should give you a notice explaining how to request the review; ask for it if you do not receive it. The notice identifies the independent review organization and the steps to take. Act promptly: the deadline and possible financial responsibility differ by setting. Read the notice and [Medicare's fast-appeal instructions](https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/fast-appeals) rather than assuming the same deadline applies to hospital and other services. Ask your care team what information supports continuing care. ## What happens after the first appeal? Medicare generally has five appeal levels, but the procedures differ by coverage. Each decision letter should explain how to proceed if you disagree. Read it carefully, note the next deadline, and ask whether another step is automatic or requires a new request. Do not assume that submitting an appeal guarantees care will remain covered while a decision is pending. For free, personalized counseling, contact your local [State Health Insurance Assistance Program (SHIP)](https://www.shiphelp.org/). Medicare also lists help at 1-800-MEDICARE (1-800-633-4227). Have the relevant notice and plan information available, but share sensitive details only through a trusted channel. For a broader overview of non-Medicare claims, see [what to do when an insurance claim is denied](https://insurafaq.com/insurance/claims-denial-appeals/). ## Sources - Medicare, "Filing an appeal" - Medicare, "Appeals in Original Medicare" - Medicare, "Appeals in Medicare health plans" - Medicare, "Appeals in a Medicare drug plan" - Medicare, "Fast appeals"