Medicare and Continuing Care

Frequently Asked Questions

34. What if a person disagrees with a decision Medicare makes about coverage or payment for a service?

A person with Medicare has the right to appeal any decision about his or her Medicare services. This is true whether the person is in Original Medicare, a Medicare managed care plan, or a Medicare prescription drug plan. If the person doesn't agree with the amount that Medicare paid, or thinks that a service has been unreasonably denied, the person can appeal.

Information on how to file an appeal is on the Medicare Summary Notice (MSN), in the health plan materials, or in the drug plan materials. If the person you care for decides to file an appeal, ask the doctor or provider for any information that may help the case. You can also call the State Health Insurance Assistance Program (SHIP) for help filing an appeal. If the person you care for wants someone to file an appeal on his or her behalf, he or she will need to complete an "Appointment of Representative" form.

For more information about appeals, visit http://www.medicare.gov to get a free copy of "Your Rights and Protections." (Under "Search Tools," select "Find a Medicare Publication.") You can also call 1-800-Medicare (1-800-633-4227) to find out if a free copy can be mailed to you. TTY users should call 1-877-486-2048.