How a Medicare appeal works — step by step, for your kind of Medicare
Every level, in the order you actually live it — what the rule requires, which forms (if any) go with it, and what happens if you win or lose.
Not sure which Medicare you have? →Medicare Advantage
Read your notice
Find out what the plan itself (the same Medicare Advantage organization that denied it) decided, and the date printed on the notice — your deadline is calculated from that date.
Know your deadline
65 days from the date on the notice. The rule (42 CFR § 422.582) gives you 60 days from when you receive the denial, and receipt is presumed to be 5 days after the notice's own date unless shown otherwise — 60 + 5 = 65 days from the notice date.
Decide who acts
If someone else — a family member, caregiver, or advocate — will speak for you, they need to be appointed first. Otherwise, skip this step.
Get the letter
CaseWhy Appeals explains the denial for free and drafts the request itself once you're ready to fight it.
Free explanation · Appeals Plus $49 when you want the letter
Gather what goes with it
The evidence checklist, and a supporting statement from your doctor or prescriber where one applies.
Send it
Send it to wherever the notice itself says to send a reconsideration request — there is no separate CMS form at this level (42 CFR § 422.582) — and record the date you sent it. That date is what starts the plan itself (the same Medicare Advantage organization that denied it)'s own clock.
Wait for the decision
The plan must decide within 30 calendar days for a request about a service you haven't received yet, 60 calendar days for a request about payment for something already provided, or 72 hours if the request is expedited (42 CFR § 422.590). If the plan upholds its denial, in whole or in part, it must automatically send your case to the Independent Review Entity — you don't have to do anything to trigger this (42 CFR § 422.590).
Decision received
Upload it. If it's overturned, you're done. If it's upheld, the next level's steps appear below.
This is how the appeal itself works. For how CaseWhy Appeals helps at each step — the free explanation, the letter, the deadlines — see how CaseWhy Appeals helps for Medicare Advantage →.
