Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Coverage & Appeals

Confusion Over a Qualifying Hospital Stay? SNF Residents Should Not Be Overpromised Coverage

Medicare will only cover care in a skilled nursing facility (SNF) after a qualifying hospital stay—an inpatient hospital stay of at least 3 days in a row. Most Medicare Advantage plans waive this requirement, but it remains a barrier to SNF coverage … [Read more...] about Confusion Over a Qualifying Hospital Stay? SNF Residents Should Not Be Overpromised Coverage

Don’t Pay Twice: Protecting Yourself from Illegal “Administrative Fees”

Periodically, we get calls at the Center asking if a physician participating in Medicare can charge an “administrative” or “annual” fee to patients covered by Medicare. Medicare prohibits such a fee for participating providers.Why These Fees Are … [Read more...] about Don’t Pay Twice: Protecting Yourself from Illegal “Administrative Fees”

Reminder: Retrospective Observation Status Appeal Deadline is Jan. 2, 2026

Thanks to a successful class action lawsuit led by the Center for Medicare Advocacy, if you were hospitalized between January 1, 2009 and February 13, 2025 and reclassified from inpatient to “observation status,” you may have the right to file a … [Read more...] about Reminder: Retrospective Observation Status Appeal Deadline is Jan. 2, 2026

Getting Repeated Termination Notices from Your MA Plan? You’re Entitled to an Explanation

Earlier this year, the Center for Medicare Advocacy highlighted updated CMS appeals guidance to Medicare Advantage plans. Effective January 1, 2025, if an MA plan’s decision to terminate coverage with a Notice of Medicare Non-Coverage (NOMNC)[1] is … [Read more...] about Getting Repeated Termination Notices from Your MA Plan? You’re Entitled to an Explanation

New CMS Rule Helps MA Plan Enrollees Against Repeated SNF Denials in the Same Episode of Care

The Center for Medicare Advocacy would like to highlight a recent legal development that may help enrollees and their families advocate for themselves when Medicare Advantage Plans prematurely deny Skilled Nursing Facility (“SNF”) care.In a … [Read more...] about New CMS Rule Helps MA Plan Enrollees Against Repeated SNF Denials in the Same Episode of Care

Disputes with Medicare Advantage Plans: Know the Difference Between Appeals and Grievances

Under Medicare law, Medicare Advantage plans and stand-alone Part D plans (“Plans”) must follow certain rules when enrollees disagree with Plan health care coverage determinations. Under the law, there are two distinct methods for raising issues with … [Read more...] about Disputes with Medicare Advantage Plans: Know the Difference Between Appeals and Grievances