I believe my Medicare was wrongly denied or stopped. How do I appeal?

The steps to take depend on what Medicare coverage you have, what decision you want to challenge, and what your situation is. Call 1-800-MEDICARE to learn what you can do in your situation.[1619] If you need help filing an appeal, contact the California Department of Aging's Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.[1620]

You can also appoint a representative to act on your behalf. This can be a family member, friend, advocate, attorney, doctor, or anyone else you choose. You can appoint a representative in 2 ways:[1621]

    Fill out and submit an “Appointment of Representative” form (see Appendix G, PG. 523).[1622]
    Along with your appeal, submit a written request that includes:
    Your name, address, phone number, and Medicare number;
    Your representative’s name, address, phone number, professional status, and relationship to you;
    A statement that clearly (1) appoints your representative, (2) authorizes release of your personal and health information to your representative, and (3) explains why you’re being represented; and
    Your signature and the date you signed; your representative’s signature and the date they signed.[1623]

HELPFUL HINTIf you are eligible for both, Medicare and Medi-Cal (“Dual Eligibility”)

Those Eligible for Both Medicare and Medi-Cal: People who qualify for both Medicare and Medi-Cal are known as “dual eligibles” or “Medi-Medis.”[1624] People typically become “dual eligible” by first being enrolled in one program and later becoming eligible for the other program. For example, someone may already meet Medi-Cal’s income requirements, and then age into Medicare when he or she turns 65. Dual eligibles do not necessarily receive the same benefits from Medicare and Medi-Cal.[1625] The majority of dual eligibles receive full Medi-Cal benefits and assistance with Medicare premiums and cost-sharing.[1626] For counseling on dual eligibility, go to Health Consumer Alliance’s (HCA) website and view their list of local HCA call centers at http://healthconsumer.org/index.php?id=partners, or visit Cal MediConnect’s website at www.calduals.org.

  1. 1619

    How Do I File An Appeal?, Medicare.gov, http://www.medicare.gov/claims-and-appeals/file-an-appeal/appeals.html

  2. 1620


  3. 1621


  4. 1622

    Available online: http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms1696.pdf

  5. 1623

    Can Someone File an Appeal for Me? Medicare.gov, http://www.medicare.gov/claims-and-appeals/file-an-appeal/appointing-a-representative/get-help-filing-an-appeal.html

  6. 1624

    Check Medi-Cal Eligibility, CalQuality.org, http://www.calqualitycare.org/learn/nursing-homes/pay/medical

  7. 1625

    Dual Eligibles Fast Facts, CalDuals, http://www.calduals.org/background/fast_facts/

  8. 1626

    Fore more information about dual eligibility, please visit: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/4091-08.pdf