How do I appeal a Medicare denial, or a discharge that feels too soon?
You can ask Medicare or your parent's plan to look at a no again. The steps and deadlines are not the same for Original Medicare and Medicare Advantage. Fast appeals, for when care is ending, have their own steps.
Start with the notice. It names the deadline and where to send the appeal.
Is care ending too soon? Ask for a fast appeal
Leaving the hospital: the hospital gives your parent a notice. It is called An Important Message from Medicare. To appeal, call the number on it by the day your parent is set to leave.
Rehab in a nursing home, home health, hospice, or an outpatient rehab center: your parent gets a notice before covered care ends. Ask for a fast appeal by noon the day before the end date on it.
Fast appeals go to a group Medicare pays to review care, called a Quality Improvement Organization (QIO). Two groups do this, Commence and Acentra. Which one depends on the state. The notice tells you who to call.
With Original Medicare: say your parent was admitted, and then the hospital moves them to observation. You can also ask for a fast appeal while they are still there. With a Medicare Advantage plan, use the plan's appeal steps.
Original Medicare: how an appeal works
Find the Medicare Summary Notice. It lists what Medicare did not pay and the date your appeal is due. Level 1 is a new look by the company that handles claims for Medicare. Use the Redetermination Request Form (CMS-20027), or follow the steps on the notice.
If the answer is still no, you have 180 days to go to level 2, using the Medicare Reconsideration Request Form (CMS-20033). After that, each level has a 60-day deadline. The table below lists all five levels.
Medicare Advantage: how an appeal works
Your parent, their representative, or their doctor must appeal to the plan within 65 days of the date on the denial notice.
The plan must decide within 30 days for care not yet given and 60 days for a bill. For a Part B drug, it is 7 days. If waiting could seriously harm your parent's health, the plan must decide within 72 hours.
If the plan still says no, it must send the case to an outside reviewer on its own. You don't have to ask.
Where to get free help
A free State Health Insurance Assistance Program (SHIP) counselor can help you read the notice and file. Find free Medicare counseling in your state. You can also call 1-800-MEDICARE (1-800-633-4227).
Drug plan (Part D) appeals have their own steps. The plan's denial notice explains them.
| Level | Who decides | Deadline to ask |
|---|---|---|
| 1. Redetermination | The company that handles Medicare claims | The date on the Medicare Summary Notice |
| 2. Reconsideration | An outside contractor | 180 days after the level 1 decision |
| 3. Hearing | A judge | 60 days after the level 2 decision. The amount in dispute must be at least $200 (2026). |
| 4. Appeals Council review | The Medicare Appeals Council | 60 days after the hearing decision |
| 5. Federal court | A federal judge | 60 days after the Council's decision. The amount must be at least $1,960 (2026). |
Source: Medicare.gov, checked 2026-10-26. Medicare Advantage appeals use levels 3 to 5 the same way after the outside review.
Checklist
- Find the notice: Medicare Summary Notice, plan denial notice, or end-of-care notice.
- Write down the deadline on it.
- For care ending too soon, call the number on the notice right away.
- Ask the doctor for a letter that explains why the care is needed.
- Keep copies of everything you send, and the date you sent it.
Common questions
How long do we have to appeal an Original Medicare denial?
Use the date on the Medicare Summary Notice for level 1. After that, level 2 is due within 180 days of the decision, and each later level within 60 days.
How long do we have to appeal a Medicare Advantage denial?
65 days from the date on the plan's denial notice.
What if the hospital is sending my parent home too soon?
Use the number on the notice called An Important Message from Medicare. Ask for a fast appeal no later than the day your parent is set to leave.
Who can help us file?
A free SHIP counselor or 1-800-MEDICARE. Your parent's doctor can also help, and can file a Medicare Advantage appeal for them.
Do you know what to do next?
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Sources
- Written by
- The PlanScout team. Updated Oct 26, 2026.
- Corrections
- See something wrong? Tell us. We fix confirmed errors within 2 business days and note the change in the page's change log.
Sources (4)
- cms.gov — Medicare Change of Status Notice (Original Medicare only) (retrieved Oct 26, 2026)
- Medicare.gov — Appeals in Original Medicare (retrieved Oct 26, 2026)
- Medicare.gov — Appeals in Medicare health plans (retrieved Oct 26, 2026)
- Medicare.gov — Fast appeals (retrieved Oct 26, 2026)
This guide is general information, not medical, legal, or financial advice. Confirm details with the provider, your plan, or a licensed professional.