How to Appeal a Medicare Denial for a Parent (2026)
By Charles “Chuck” Brodsky, Co-Founder, MediNav · Updated July 2026
Your parent's claim was denied? As an adult child you can appeal on their behalf, and appeals often win. The steps, the deadlines, the five levels of appeal, and how to get appointed as their representative.
A denial is not the final word. Medicare, Medicare Advantage plans, Part D plans, and Medicaid all have a formal appeals process, and a meaningful share of appeals succeed, especially when a doctor supports the request. Here's how to appeal a denial for your parent, step by step.
First, make sure it's actually a denial
Not every scary letter is a denial. A Medicare Summary Notice or an Explanation of Benefits is just a statement of what was billed and paid, not a bill and not a denial. A denial specifically says a service, item, or medication will not be covered, and explains why. If that's what your parent got, it's appealable, and time-sensitive.
Get appointed as your parent's representative
To file and handle an appeal for your parent, you'll usually want to be their appointed representative using Form CMS-1696 (Appointment of Representative). Both you and your parent sign it, and it lets you submit the appeal, send evidence, and speak for them on that matter. Set this up as soon as a denial arrives so paperwork doesn't cost you days you don't have.
Watch the deadline, it's the thing people miss
The denial notice lists the exact date you must appeal by. It's often 60 days for a Medicare Advantage or Part D plan and up to 120 days for a redetermination under Original Medicare, but always go by the date on the letter. Send the appeal (by certified mail if you can, for proof) before that date. If your parent is being discharged from a hospital or losing a service they're still receiving, ask about a fast (expedited) appeal, which is decided in days.
The five levels of appeal
If the first answer is still no, you can keep going. The levels are: (1) a redetermination by Medicare, or a reconsideration by the plan; (2) review by an independent organization; (3) a hearing with an Administrative Law Judge; (4) the Medicare Appeals Council; and (5) federal court. Most cases are resolved at the first or second level, so don't be discouraged by an early denial.
What makes an appeal succeed
Three things carry most appeals: a clear explanation of why the service should be covered, a supporting note from your parent's doctor stating it's medically necessary, and meeting the deadline. Follow the specific instructions on the denial notice for where and how to send it, sending it to the wrong place is a common, avoidable mistake.
Let MediNav draft the letter
You don't have to write the appeal from scratch. Describe what was denied and why it should be covered, and MediNav's free Appeal tool drafts a formal letter you can print, sign, and mail. Pair it with the authorized-representative form and your doctor's note, and you're ready to send.
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Start the free check →Frequently asked questions
Can I appeal a Medicare denial for my parent?
Yes. Once you're appointed as your parent's representative, usually with Form CMS-1696, you can file and handle the appeal on their behalf, including submitting evidence and speaking with Medicare or the plan about it.
How long do we have to appeal a Medicare denial?
The deadline is printed on the denial notice, often 60 days for a Medicare Advantage or Part D plan and up to 120 days for a redetermination under Original Medicare. Always follow the date on the letter, and file before it.
How many times can you appeal a Medicare denial?
There are five levels of appeal: a first review by Medicare or the plan, an independent review, an Administrative Law Judge hearing, the Medicare Appeals Council, and finally federal court. Most cases are settled at the first or second level.
Do Medicare appeals actually work?
Often, yes, a meaningful share of appeals are successful, particularly when the beneficiary's doctor provides a note explaining that the service is medically necessary and the appeal is filed on time.
Updated July 2026. Sources: Medicare.gov, SSA, CMS (2026). Estimates, verify with SSA and your state.