A Right to Know: An Overview of the Original Medicare Appeal Process


If you are enrolled in a Medicare plan, you automatically have a number of rights.  One of the most essential rights is the right to appeal.  The right to appeal (a complaint you make when you disagree with a decision made by your Medicare plan), is guaranteed to all Medicare recipients.

Some conditions under which you may choose to file an appeal are, for instance, if you are denied coverage for care you’ve already received, if you are denied a request for a service, supply, or prescription (or if it is not covered and you think it should be), or if your plan stops paying for a service you are currently getting coverage for.

If you decide to file an appeal, how to proceed depends on what type of plan you are enrolled in.  Medicare Advantage Plans and Prescription Drug Plans have specific procedures in place to allow you to use the appeal process.  They should include this information in the materials you receive from them. Similarly, Original Medicare also has specific procedures in appealing a decision. 

The first step in the Original Medicare Plan is to obtain the Medicare Summary Notice where the service you are appealing appears.  Next, you need to circle the item to which you object.  You then need to explain, in written form, why you disagree.  You will want to write this explanation on the MSN. Include your telephone number and signature.  Finally, send it (or a copy) to the address in the “Appeals Information” section of the MSN.  You need to file this appeal within 120 days of when you receive the MSN. 

It’s essential, when considering filing an appeal, to follow the instructions on your MSN.  There are also a number of resources to help you with this process.  Call your State Health Insurance Assistance Program for more information, or 1-800-MEDICARE. 


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