This section guides you through the Medicare Part D appeals process, which is the same whether a person has a stand-alone Part D plan (PDP) or a Medicare Advantage Plan with prescription drug coverage (MAPD). We will review the reasons beneficiaries might want to appeal, including the drug they need is not covered by their plan, the drug is covered but there are coverage restrictions on the drug, or the drug is covered but they want to request a tiering exception in order to pay a lower copay. You will learn the specifics of the first pre-appeal step, and then we will detail the five levels of appeal within both standard and expedited timeframes. You will gain valuable tips to help people with Medicare move effectively through the appeal process, such as how to properly complete paperwork and how to enlist a doctor to support your appeal.

Learning Objectives

After taking this section, you will be able to:

  • Identify when a beneficiary may start a Part D appeal
  • Explain the difference between Part D standard and expedited appeals
  • Understand the steps in the Part D appeal process


  • Interactive activities and knowledge quizzes
  • Review tests at the end of every section – 80% or higher mark to pass the section and download a certificate of completion
  • Educational content vetted by a team of national experts at Medicare Rights Center
  • Closed captioning
  • An array of printable supplementary tools and fliers