How can I file a Medicare appeal? APPEALS
The "Medicare & You" handbook
MEDICARE APPEALS
An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare Advantage plan.
For example, you can appeal if Medicare or your plan denies:
DENIES A request for a health care service, supply, item, or drug you think Medicare should cover.
DENIES A request for payment of a health care service, supply, item, or drug you already got.
DENIES A request to change the amount you must pay for a health care service, supply, item, or drug.
You can also appeal:
If Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or drug you think you still need.
An at-risk determination made under a Drug Management Program that
limits access to coverage for frequently abused drugs, like opioids and benzodiazepines.
Medicare & You | Medicare Section 8 "Your Medicare Rights & Protections"
contains more in-depth, detailed information regarding appeals and how to file a complaint.
The "Medicare & You" handbook is your official guide to Medicare.
We mail an updated printed handbook to all Medicare households in late September.
You can download a copy anytime, or access it electronically for the most updated information available.
The handbook is available in many formats and languages, including large print, braille, and more.
Keep your handbook as a reference. It has important information about:
Medicare benefits, costs, rights, and protections.
Health and drug plans.
Answers to common questions.
PA MEDI-certified counselors can assist you with questions and help you through the appeal process, call your local PA MEDI program or the
PA MEDI Helpline at 1-800-783-7067 for assistance.