Medicare Appeal Denied? Don’t Stop Yet.
Medicare & Advantage Plan Denials? Don’t Stop After the First “No”
If Medicare (Original or Advantage) denies your appeal, don’t assume that’s the end. In my experience, first-level appeals—often called redeterminations or reconsiderations—get denied a lot. But that doesn’t mean your case is hopeless. Many people win at Level 2 or beyond, especially when they stick with it.
Why you should keep going:- For Original Medicare, there are 5 appeal levels, and you typically have the right to move to the next one if you're denied.- For Medicare Advantage, you also have 5 levels: starting with a plan reconsideration, then an independent review (IRE), then hearings up through federal court.- In 2022, only ~10% of Medicare Advantage denials were appealed—but of those, 83% were reversed.
What to do:1. Review the denial letter carefully—it tells you how to appeal and the deadline.2. Gather supporting evidence—doctor notes, test results, medical records.3. File your appeal on time, or explain if you’re late; it’s often allowed.4. Don’t stop at one denial—there are multiple levels for a reason.
For help getting started, here’s the official Medicare guide explaining your rights and all the appeal levels:- Learn more and get forms at Medicare.gov: • Appeals in Medicare Advantage plans: https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/medicare-health-plans • Appeals in Original Medicare: https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/original-medicare- Background data on reversals: https://www.investopedia.com/the-truth-about-medicare-advantage-claim-denials-and-how-you-can-appeal-8762198
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