Like private insurance, Medicare and Medicaid have appeal options

Like people with private group and individual health plans, anyone with Medicare and Medicaid has the right to appeal coverage decisions.

Medicare

Visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227) to learn more about what Medicare covers and how to manage claims and appeals.

Note that Medicare is a public health program and is not required to abide by many of the Patient Protection and Affordable Care Act (ACA) rules. For more information, visit healthcare.gov.

Medicaid

Each state manages its Medicaid program independently. If you have questions or concerns about your Medicaid benefits or coverage, contact your state program.

Medicaid is a public health program, and may not be required to abide by all of the Patient Protection and Affordable Care Act (ACA) rules. If you qualify for Medicaid based on your state’s decision to expand Medicaid under the ACA you are entitled to the same screening and preventive services as people who are covered by private insurance. If you who qualify based on other traditional Medicaid eligibility pathways, cancer screening and preventive services are considered “optional” and the scope of coverage is determined by the state. For more details, visit healthcare.gov.