The Right to Appeal a Medicare Decision Explained

You can appeal if Medicare or your plan denies one of these:

• Your request to get a health care service, item, or drug you think should be covered, provided, or continued.
• Your request for payment for a health care service, item, or drug you already got.
• Your request to change the amount you pay for a health care service, item or drug.

The appeals process has five levels, and you can generally go up a level if your appeal is denied at a previous level. Gather any information that may help your case from your doctor, health care provider or supplier. If you think your health would be seriously harmed by waiting for a decision, you can ask for a fast decision to be made and if your doctor or Medicare plan agrees, the plan must make a decision within 72 hours.

The final word. Just like the leaves that begin to fall in Autumn signals a change in the weather, so should it send a signal to Medicare eligibles to consider a change, or at least a review of their Medicare plan. Autumn represents the preservation of life and basic necessities – and who could argue that Medicare is not a basic necessity, too!