Can I appeal my Medicare Prescription Drug Plan's decisions?

If your plan doesn't respond to your request for a drug, an appeal, or an exception, you can file a grievance with the plan sponsor, or file a complaint by calling 1-800-MEDICARE (1-800-633-4227), or both. TTY users should call 1-877-486-2048.

A standard request must be made in writing unless your plan accepts requests by phone. You or your doctor can call or write your plan for an expedited (fast) request. Once your Medicare drug plan gets your request for a Coverage Determination (Part D), the Medicare drug plan has 72 hours (for a standard request) or 24 hours (for an expedited request) to notify you of its decision. If you are requesting an Exception , your prescribing doctor must provide a statement explaining the medical reason why your request should be approved. Your plan generally has 72 hours (for a standard request) or 24 hours (for an expedited request) to notify you of its decision once your plan receives your doctor's statement.

If you disagree with your Medicare drug plan's decision, you have the right to appeal. You must request the appeal within 60 calendar days from the date of the decision. A standard request must be made in writing unless your Medicare drug plan accepts requests by phone. You can call or write your plan for an expedited request. Once your Medicare drug plan receives your request for an appeal, the Medicare drug plan has seven days (for a standard request for coverage) or 72 hours (for an expedited request for coverage) to notify you of its decision.

(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)