After No
Urgent help
Menu Close
Part of: Bills and help

Guide · the basics · 4 minute read

Medicare counseling through the State Health Insurance Assistance Program

Every state has a free Medicare counseling program that is not tied to any insurance company. Here is what it does, how to reach it, and when to call 1-800-MEDICARE or a quality improvement organization instead.

Applies to: Medicare

Key points

  • A State Health Insurance Assistance Program gives free, one-on-one Medicare counseling and is not connected to any insurance company. There is one in every state.
  • Find yours at shiphelp.org or 877-839-2675. You can also call 1-800-MEDICARE, 1-800-633-4227, which is open every day.
  • Fast appeals of hospital discharges and the end of some services go to a quality improvement organization, not to a counselor, and the deadlines are very short.
  • Counseling does not stop your appeal clock. For Original Medicare the first appeal is due within 120 calendar days of receiving the decision.
On this page 6

If you have Medicare, call your State Health Insurance Assistance Program (SHIP) early. It is free, the counselors are not connected to any insurance company, and every state has one. Counseling helps you understand and plan, but it does not pause any deadline, so read your notice first.

What this means

A SHIP gives one-on-one counseling about Medicare, including help with complaints and appeals. The Administration for Community Living lists 54 grantees: the 50 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. Medicare.gov names SHIP on every relevant page, including help to file a complaint or an appeal. Your state may use another name. Our state pages show your state’s program name and number where we have them.

Other free helpers do different jobs:

  • 1-800-MEDICARE is 1-800-633-4227, text telephone 1-877-486-2048, and Medicare.gov says it is open 24 hours a day, 7 days a week. You reach a person by phone or live chat.
  • The Medicare Beneficiary Ombudsman helps with complaints, grievances, appeals and information requests that the plan or 1-800-MEDICARE has not resolved. You reach it by asking a 1-800-MEDICARE representative to submit the issue.
  • Quality improvement organizations (called Beneficiary and Family Centered Care Quality Improvement Organizations) handle fast appeals of hospital discharges and of the end of some services, and quality-of-care complaints, free of charge. The two current contractors are Acentra Health and Commence Health. The Centers for Medicare & Medicaid Services publishes a map showing which one serves your state.

What to do

  1. Find your notice and its date (your step). In Original Medicare the first decision comes on a Medicare Summary Notice, which is not a bill. A Medicare Advantage or drug plan sends its own notice. Check the date on your notice, which controls.
  2. Call your SHIP. Find it at shiphelp.org or 877-839-2675. Ask for a counselor who handles appeals.
  3. Bring the facts. Have the notice, the service and the date, the name of the plan if you have one, and what you want. Write down the counselor’s name and what they promised to do.
  4. Ask what the counselor can do. Some help you write the appeal. Some call the plan. Some can only explain. Ask which, and by when.
  5. For a fast appeal, do not wait for a counselor. If you are being discharged from a hospital, you must ask the quality improvement organization for a fast review no later than the day you leave. If a skilled nursing facility, home health or similar service is ending, you must ask by noon of the calendar day after you receive the notice. The number is on your notice. See Medicare fast appeals.
  6. Keep your own appeal clock. For Original Medicare, a first appeal is due within 120 calendar days of receiving the decision, and receipt is presumed 5 calendar days after the date on the notice. Other Medicare plans have their own deadlines. See the five levels of Original Medicare appeals.
  7. If the counselor will act for you, sign what they need. For Original Medicare a person can be appointed as representative on Form CMS-1696. See acting for someone else.
  8. If the plan or 1-800-MEDICARE has not solved it, ask 1-800-MEDICARE to send the issue to the Ombudsman.

What the counselor may say, and what to say back

“We cannot file the appeal for you.” Can you review my letter before I send it, and tell me what to include and where to send it?

“The next appointment is in two weeks.” My deadline is on the notice. Can someone help sooner, or can you tell me who can?

The rule

The Medicare Summary Notice must give reasons for the decision and explain how to ask for a redetermination, and the request must be filed within 120 calendar days of receiving the initial determination. See Code of Federal Regulations (CFR), title 42, section 405.942.

Watch for

  • Paper notices come slowly. Medicare.gov says the paper Medicare Summary Notice is mailed every 6 months if you received services in that period. Check claims in your online Medicare account sooner so your 120 days do not run unseen.
  • Many websites repeat old information. Use the official page or your counselor to confirm numbers and dates.
  • Medicare and Medicaid together. If you have both, ask the counselor which program’s rules apply to the service.

What next

Sources

Official and primary sources used on this page. Checked 2026-11-12.

  1. State Health Insurance Assistance Program — Administration for Community Living
  2. Get help with your rights and protections — Medicare.gov
  3. Contact Medicare — Medicare.gov
  4. Medicare Beneficiary Ombudsman — Centers for Medicare & Medicaid Services
  5. Beneficiary and Family Centered Care Quality Improvement Organizations — Centers for Medicare & Medicaid Services
  6. Quality improvement organization regions — Centers for Medicare & Medicaid Services
  7. Original Medicare redetermination, 42 CFR 405.942 — Electronic Code of Federal Regulations
  8. Hospital discharge appeals, 42 CFR 405.1206 — Electronic Code of Federal Regulations

What next

Letters and scripts

  • Letter or script

    Medicare redetermination request

    Ask the Medicare contractor to review again a decision on your Original Medicare claim. This is the first appeal, called a redetermination.

  • Letter or script

    Medicare Advantage reconsideration request

    Ask your Medicare Advantage plan to review its denial again. The plan's appeal is called a reconsideration, and an outside reviewer sees the case if the plan says no.

  • Letter or script

    Medicare drug plan exception request

    Ask your Medicare drug plan to cover a drug that is not on its list, or to charge a lower cost-sharing tier. Your prescriber must support the request.

  • Letter or script

    Name someone to act for you

    A plain written statement naming a family member, friend or advocate to speak and write to your health plan for you about a claim or appeal. It does not replace the plan's own form.

Tools

  • Tool

    Medicare appeal navigator

    Find your level in the Medicare appeal process, the next level, the form and the time limit.

  • Tool

    Find help near you

    Pick your state and coverage and see the regulator, the free consumer program and the Medicare counselors for you.

  • Tool

    Deadline calculator

    Turn the date on your notice into the dates you and the plan each have to meet, with the rule behind each one.

Checklists

  • Checklist

    Medicare appeal

    The notices to look for, the forms and the deadlines at each level of a Medicare appeal, including fast appeals for hospital discharge and ending services.

Related guides

  • Guide

    Original Medicare: the five appeal levels

    A plain walk through the five levels of a Medicare Parts A and B appeal. It starts from the Medicare Summary Notice. It names the deadlines that trip people up and what to do first.

  • Guide

    Medicare Advantage appeals

    How to appeal when a Medicare Advantage plan refuses to approve or pay for care. Learn the 65-day deadline, the plan's decision times (including the 2026 prior authorization rule) and the automatic outside review.

  • Guide

    Medicare drug plan appeals and exceptions

    What to do when a Medicare drug plan will not cover a prescription. Ask for a coverage decision or an exception, then appeal. The outside review step is not automatic.

  • Guide

    Fast appeals when a hospital or facility is ending your care

    A hospital says you are being discharged, or a nursing facility, home health agency, rehabilitation facility or hospice says Medicare coverage is ending. You can ask for a fast review. Time of day matters.

  • Guide

    Medicare observation status

    If a hospital admitted you and then changed you to observation, you may have a right to appeal that change, but only before you leave the hospital. Learn who qualifies, what notice to expect and what has closed.

  • Guide

    Where to get free help, by coverage type

    The right free helper depends on who regulates your plan. Here is a map from job-based, Marketplace, Medicare, Medicaid and military coverage to the people who can help at no cost.

  • Guide

    Acting for someone else

    You can usually help a parent, partner or adult child with a denial if they give written permission. Here is how to name a representative with plans, Medicare and Medicaid, and what this page does not cover.

This page is general information, not legal or medical advice. Your notice, your plan document and the law that applies to your coverage control.

Sources last checked . Found a mistake? Report it.