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How Do You File a Medicare Appeal?

Learn how to file a Medicare appeal, which decisions can be challenged, and why the steps depend on Original Medicare or plan coverage.

Direct answer

You can file a Medicare appeal when Original Medicare or your Medicare plan refuses to cover, pay for, continue, or change the cost of a service, supply, item, or drug you believe should be covered. The first step depends on your coverage type: Original Medicare appeals usually start from the Medicare Summary Notice or redetermination request, while Medicare Advantage and drug-plan appeals follow the plan's written instructions.

coverage type + decision notice = correct Medicare appeal path

Appeal path by coverage

Original Medicare denial

MSN or redetermination form

Use the deadline on the MSN

Medicare Advantage issue

Plan appeal instructions

Plan must explain appeal rights in writing

Part D drug issue

Drug plan appeal process

Follow plan timing rules

Service ending too soon

Fast appeal notice

Act quickly before services end

Quality or service complaint

Complaint or grievance path

Not the same as an appeal

Coverage or issue	Where to start	Key caution
Original Medicare denial	MSN or redetermination form	Use the deadline on the MSN
Medicare Advantage issue	Plan appeal instructions	Plan must explain appeal rights in writing
Part D drug issue	Drug plan appeal process	Follow plan timing rules
Service ending too soon	Fast appeal notice	Act quickly before services end
Quality or service complaint	Complaint or grievance path	Not the same as an appeal

Appeals and complaints are different

Use an appeal when you are challenging a coverage, payment, service-ending, or cost decision. Use a complaint or grievance for service quality, access, behavior, or administrative problems that are not the same as a coverage decision.

Start the appeal

1Identify whether the decision came from Original Medicare, a Medicare Advantage plan, another Medicare health plan, or a drug plan.
2Read the written notice or MSN for the deadline and appeal address.
3Gather the denied item, service dates, Medicare Number, and why you disagree.
4Ask your provider or supplier for supporting information if it helps your case.
5Submit the appeal using the notice, form, plan instructions, or fast-appeal path that applies.

FAQ

What Medicare decisions can I appeal?

You can appeal coverage, payment, cost-sharing, service-ending, and certain drug-management decisions when Medicare or your plan refuses, reduces, or stops something you believe should be covered.

Is a Medicare complaint the same as an appeal?

No. An appeal challenges a coverage or payment decision. A complaint or grievance is a separate process for service or quality concerns.

Where do I start an Original Medicare appeal?

Start with your Medicare Summary Notice or the redetermination form, then send the appeal to the Medicare Administrative Contractor listed in the MSN instructions.

Sources & method

We reviewed these references while writing this answer. Figures are estimates — confirm safety-critical work with a professional. Last updated June 7, 2026.