How do I file an appeal?

An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan. For example, you can appeal if Medicare or your plan denies:

• A request for a health care service, supply, item, or drug you think Medicare should cover.
• A request for payment of a health care service, supply, item, or drug you already got.
• 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.