How To File A Medicare Advantage Appeal

How To File A Medicare Advantage Appeal-500x333

How To File A Medicare Advantage Appeal

If you have a Medicare Advantage plan then you are already aware that it covers all of Part A and Part B services. In addition, most Medicare Advantage plans offer prescription drug coverage (also known as Part D), along with vision, hearing, and dental coverage.

  1. Part A (hospital insurance) covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home health care.
  2. Part B (Medical Insurance) covers doctor appointments, outpatient services, medical equipment, home health care, and some preventative services.

While many items and services are covered under Medicare Advantage plans such as prescription drugs, diabetic test supplies, cardiovascular screenings, and hospital visits, there may be items or services not covered. What should you do if your Medicare Advantage plan does not cover the cost of an item or service you need? According to, you have the right to ask your Insurance Company to provide or pay for items or services you think should be covered, provided, or continued. The decision by the Medicare Advantage plan is called an “organization determination.” Filing an appeal helps you to resolve these differences with your plan.

If you disagree with your plan’s initial decision, you can file an appeal. The appeals process has five levels. If you disagree with the decision made at any level of the process, you can generally go to the next level. At each level, you’ll get instructions in the decision letter on how to move to the next level of appeal.

4 Tips to File an Appeal from

  1. Get Help: If you want help filing an appeal, contact your State Health Insurance Assistance Program (SHIP) or appoint a representative. Your representative could be a family member, friend, advocate, attorney, doctor, or someone else who will act on your behalf.
  2. Gather Information: Ask your doctor, other health care providers, or supplier for any information that may help your case.
  3. Keep Copies: Be sure to keep a copy of everything you send to your Insurance Company as part of your appeal.
  4. Start the Process: Follow the directions in your plan’s initial denial notice and plan materials. You have 60 days from the date of the coverage determination. If you miss the deadline, you must provide a reason for filing late. See what information to include in your written request.

Once you start the appeals process, you can disagree with the decision made at any level of the process and can generally go to the next level. Learn more about appeals in a Medicare Advantage Plan.

Got Medicare Advantage Questions?

Medicare Advantage enrollment has grown rapidly over the past decade with more than one-third (36%) of all Medicare beneficiaries opt for a Medicare Advantage plan. The majority of enrollments come from nine states (HI, FL, MN, OR, WI, MI, AL, PA, CT) and Puerto Rico. We hope this information on How To File A Medicare Advantage Appeal is helpful to you.

Stay on top of your health. If you have questions about your Medicare coverage, call Empower today. Let us help with your Medicare questions so you can get back to the activities you enjoy the most. 1-888-446-9157 or click here to get an INSTANT QUOTE

Leave a comment

Your email address will not be published. Required fields are marked *