The short answer
If your Medicare Advantage plan denies a service or a claim, you don't have to accept it. You have formal appeal rights, and appeals succeed more often than people expect. The process moves through levels — starting with asking the plan to reconsider and escalating to independent review if needed — each with its own deadline.
The most important thing is to act promptly and follow the steps, because appeals are time-sensitive and giving up early is the most common mistake.
The levels of appeal
The first level is a reconsideration by the plan itself — you (or your doctor) ask the plan to review its denial, often with additional documentation of medical necessity. If the plan upholds the denial, the case moves to an independent review entity that isn't part of your plan, and further levels exist beyond that. For urgent situations where waiting could harm your health, you can request an expedited (fast) appeal with a much shorter timeline.
Your denial notice explains your specific appeal rights and deadlines, so read it carefully. A denial that stems from a prior authorization is common — our guide to prior authorization in Medicare Advantage covers how those work.
How to strengthen your appeal
Appeals win on documentation. Get your doctor involved early — a clear letter explaining why the service is medically necessary carries real weight. Keep copies of everything, note every deadline, and submit before the clock runs out. If a service is time-sensitive, ask for the expedited process.
If an appeal isn't resolving a broader problem with how the plan treats you, you can also file a grievance, which is a separate complaint process. Our guide to filing a Medicare grievance explains when to use it alongside an appeal.
Frequently Asked Questions
Can I appeal a Medicare Advantage denial?
Yes. You have formal appeal rights through several levels, starting with asking the plan to reconsider and escalating to independent review. Appeals succeed more often than people expect.
How long do I have to appeal?
Deadlines are set out in your denial notice and are time-sensitive. For urgent situations, you can request an expedited appeal with a much shorter timeline. Act promptly.
How do I improve my chances of winning an appeal?
Get your doctor to document medical necessity clearly, keep copies of everything, meet every deadline, and use the expedited process for time-sensitive care.
What's the difference between an appeal and a grievance?
An appeal challenges a denial of coverage or payment. A grievance is a separate complaint about how the plan treats you, such as service quality. You can use both when appropriate.
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