Denied by Medicare? You have an appeal, a deadline, and a real shot.
Medicare is four different appeal systems wearing one name. Tell us which one denied you and we will build your fight plan: your exact deadline, your next move with the real form and phone number, and what it costs you to walk away.
Your Fight Plan
Medicare · 2026 rules
Which Medicare said no?
Each kind has its own appeal, its own form, and its own deadline. Pick the one that matches your denial so you get the right plan.
Frequently Asked Questions
How do I appeal a Medicare Advantage denial?
File a reconsideration with your plan within 60 days of the denial, in writing if you can, and ask for a fast decision if waiting could hurt your health. Attach a short statement from your doctor explaining why you needed the care. The odds are strong: in 2024, more than 80 percent of appealed Medicare Advantage denials were overturned. If the plan says no again, it must forward your case to an independent reviewer on its own, so you do not refile.
The hospital says Medicare won't cover more days. What do I do?
Do not leave and do not start paying. Use the 'Important Message from Medicare' notice you signed, and call your Quality Improvement Organization (the QIO) by the day you are set to be discharged. Its number is on the notice, or call 1-800-MEDICARE. The QIO decides in about a day, and you are not billed for the stay while it reviews. If the reason is that you 'stopped improving,' the Jimmo rule makes that reason invalid on its own.
What is the Medicare appeal deadline?
It depends on which Medicare denied you. For Original Medicare, you have 120 days from the Medicare Summary Notice (about 125 days from the date on it) to file a redetermination. For a Medicare Advantage plan, 60 days from the denial. For a Part D drug plan, 60 days from the coverage determination. And for care that is ending now, a hospital discharge or a nursing, home health, or hospice cutoff, the deadline is measured in hours, so call the QIO the same day.
My drug plan won't cover my prescription. How do I appeal?
First get a coverage determination from the plan, because the pharmacy counter 'no' is not something you can appeal yet. You or your prescriber can request it, and the plan must decide in 72 hours, or 24 hours if it is urgent. If the drug is not on the list or is on a high tier, ask for an exception, which needs your prescriber's statement that the alternatives would not work or would harm you. If the determination is a denial, file a redetermination within 60 days.
Does Medicare cover nursing home or custodial care?
Original Medicare does not pay for custodial care, help with daily activities like bathing, dressing, and eating, when that is the only care you need. It does cover short-term skilled nursing care after a qualifying hospital stay. If your skilled care is being cut off because you 'plateaued,' that is not a legal reason on its own under the Jimmo rule, and you can appeal fast by calling the QIO.