You did everything right. You compared plans during the Annual Enrollment Period, picked one that looked like a better fit for 2027, and made the switch before December 7. Then January rolled around and a claim or service got denied anyway. It feels unfair, maybe even like the new plan tricked you. Here's the good news: switching plans did not cost you any appeal rights, and the new plan owes you the exact same process the old one did.
Switching Plans Doesn't Reset Your Appeal Rights
Some people assume that because they're new to a plan, they have fewer protections or less standing to push back on a denial. That's not true. Every Medicare Advantage plan, no matter how new your enrollment is, has to follow the same federal appeal rules as every other plan. Your rights to reconsideration, to an independent review, and even to an expedited decision when your health is on the line don't depend on how long you've been a member.
What's actually going on is simpler, and a little frustrating: coverage rules, prior-authorization requirements, and formularies are set fresh for each plan year and reset every January 1. A service that was approved or covered without a fight in 2026 can suddenly require prior authorization, or get denied outright, under a different plan in 2027, even though nothing about your health has changed. This is a normal, common pattern at the start of a new plan year, not a sign that something went wrong with your enrollment.
What the Denial Notice Actually Looks Like
If your new Medicare Advantage plan denies coverage or payment, the notice you receive has an official name: the Notice of Denial of Medical Coverage or Payment, often called the Integrated Denial Notice. Medicare Advantage members don't get a Medicare Summary Notice the way Original Medicare enrollees do; instead, you'll see an Explanation of Benefits from your plan for claims generally, and this specific denial notice when something is turned down. Keep it. The date printed on it starts your appeal clock.
The Level 1 Appeal: Plan Reconsideration
Your first step is asking the plan itself to reconsider its decision. This is called a Level 1 appeal, or plan reconsideration, and the deadline is 65 calendar days from the date on the denial notice. That's true whether you're filing a standard appeal or an expedited one, and it's worth noting that this deadline runs from the date printed on the notice, not from whenever the letter happened to arrive in your mailbox. That makes it easier to track: no guessing about mail delays, just count from the date on the page.
If you miss that window, you can ask for a good-cause extension, so don't assume a late filing automatically kills your appeal. But don't rely on that as a backup plan either. File as soon as you can.
Need help writing the actual request? Our Medicare denial appeal letter template walks through what to include so your reconsideration request is complete the first time.
If the Plan Says No Again
If your plan reviews its own denial and upholds it, you don't have to file anything new to move to the next level. Medicare Advantage denials that are upheld at Level 1 are automatically forwarded to the Independent Review Entity, an outside contractor that works for CMS and is not part of your plan. This automatic forwarding is one of the more reader-friendly parts of the process: you don't have to know how to find the IRE or fill out a separate form to get that independent look.
When You Can't Afford to Wait
If waiting for a standard decision would jeopardize your health, ask for an expedited appeal. Expedited Medicare Advantage reconsiderations, including appeals involving Part B drugs, must be decided within 72 hours. There is no shorter, 24-hour exception at the appeal stage; that faster 24-hour clock only applies to certain initial coverage requests before a denial has even happened, not to appeals. If your situation feels urgent, say so clearly and ask for the expedited track by name.
The New-Plan Trap: Old Approvals Don't Automatically Follow You
Here's the part that catches switchers off guard the most. If your old 2026 plan had approved a service, a procedure, or an ongoing treatment, that approval belonged to that plan. It does not automatically transfer to your new 2027 plan. Your new plan is a separate entity with its own prior-authorization list and its own Evidence of Coverage, and it may require fresh authorization for care that was already settled under your old coverage, even if nothing about your diagnosis or treatment plan has changed.
This is exactly why so many January denials land on people who switched plans in good faith. It isn't usually a mistake or a punishment. It's simply how per-plan-year coverage rules work.
The fix is to get ahead of it in writing. As soon as you enroll, or as soon as you suspect a gap, send your new plan a written request asking exactly what is on file for you: what prior authorizations have carried over, what your Evidence of Coverage says about your specific treatment, and what their prior-authorization list requires going forward. A written answer gives you something concrete to point to if a denial shows up later, and it may catch a problem before it turns into one.
If You're Already Mid-Treatment
If you were in an active course of treatment when you joined the new plan, meaning you were already seeing a provider and actively following a treatment plan, federal rules require the plan to give you a transition period of at least 90 days without disrupting that care or demanding reauthorization. This applies whether you're new to that plan or new to Medicare altogether, and it applies even if your provider is out-of-network for the new plan. Separately, if a prior authorization was already approved for a course of treatment, that approval stays valid for as long as the treatment remains medically necessary, so an approval in hand shouldn't simply expire mid-course.
Because plans can be more generous than the federal floor, don't guess. Ask your new plan in writing exactly how long your specific existing approval or treatment plan is protected. Get the answer in writing, and keep it with your records.
Don't Give Up After a First Denial
It's tempting to assume a denial is the final word, especially when you're already frustrated about switching plans for what felt like a better deal. Don't stop there. Denials are often overturned on appeal, and most people who receive one never even file an appeal to find out. Filing a reconsideration, especially one that includes your provider's supporting documentation and a clear written record of what your new plan told you about your coverage, is a real path forward, not a formality.
What Happens If the Plan Upholds the Denial Again
If the Independent Review Entity also upholds the denial, you have further levels of appeal:
- Level 3: a hearing before an Administrative Law Judge, filed within 60 calendar days of receiving the Level 2 decision.
- Level 4: review by the Medicare Appeals Council, filed within 60 calendar days after receiving the ALJ's decision.
- Level 5: judicial review in federal district court, filed within 60 calendar days after receiving the Appeals Council's decision.
Each of those later deadlines runs from when you receive the notice, which is presumed to be 5 calendar days after the decision date unless you can show otherwise. That's a different clock than the Level 1 deadline, which runs strictly from the date printed on the notice, so pay attention to which stage you're at before you count days.
A Few Things Worth Remembering
- Switching plans during AEP does not reduce your appeal rights in any way.
- New-year denials for previously approved care are common because coverage rules reset every January 1, not because of anything you did wrong.
- An old plan's approval does not automatically transfer; ask your new plan in writing what is on file.
- If you're mid-treatment, you're entitled to a transition period of at least 90 days without disruption.
- Always confirm current deadlines, forms, and dollar amounts at Medicare.gov or by calling 1-800-MEDICARE, since details can be updated over time.
If a January denial has landed on your desk, your best next move is to get your written reconsideration request started now, while the 65-day clock is fresh. Our Medicare denial appeal letter template can help you put together a clear, complete request the first time.
FAQ
Does switching Medicare Advantage plans during AEP reduce my appeal rights?
No. Every Medicare Advantage plan has to follow the same federal appeal rules regardless of how long you've been enrolled. Switching plans does not reduce or reset your appeal rights in any way.
What notice will I get if my new Medicare Advantage plan denies a claim?
You'll receive a Notice of Denial of Medical Coverage or Payment, commonly called the Integrated Denial Notice. Medicare Advantage members get an Explanation of Benefits from their plan for claims generally, not a Medicare Summary Notice, which only goes to Original Medicare enrollees.
How long do I have to file a Level 1 appeal with my Medicare Advantage plan?
You have 65 calendar days from the date on the denial notice to file a Level 1 plan reconsideration, whether it's a standard or expedited request. If you file late, you can ask for a good-cause extension.
Does an approval from my old Medicare Advantage plan carry over to my new plan?
Not automatically. Your new plan has its own prior-authorization list and Evidence of Coverage, so care approved under your 2026 plan may need fresh authorization from your 2027 plan. Ask your new plan in writing what is already on file for you.
What protection do I have if I'm already in treatment when I switch plans?
If you're in an active course of treatment, your new plan must give you a transition period of at least 90 days without disrupting that care or requiring reauthorization, even if your provider is out-of-network. Confirm the specifics with your plan in writing since plans may offer more than the minimum.
What happens if my Medicare Advantage plan upholds its own denial?
If the plan upholds the denial at Level 1, it is automatically forwarded to the Independent Review Entity for an independent look, with no separate filing needed from you. If that's also unfavorable, further appeal levels exist, including a hearing before an Administrative Law Judge.
Denied? You don't have to fight alone.
DENIED. — The Insider's Manual to Winning Your Medicare Advantage Appeal walks you through every step and includes 5 ready-to-send appeal letters you can fill in and mail today.
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This article is general education, not legal or medical advice. Medicare rules, deadlines, and dollar amounts change; confirm the current details for your situation at Medicare.gov or by calling 1-800-MEDICARE. MedicareClaimDenied.com is not affiliated with or endorsed by Medicare, CMS, or any insurer.