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Grievance, Exceptions, and Appeals

Grievances, exceptions, and appeals are ways that Medicare has set up for you to try to solve problems with your plan. For example, your pharmacy might tell you that your plan will not pay for the drug your doctor ordered for you. Or they might tell you that a prescription will cost more than you can afford to pay.

There are specific ways to solve different kinds of problems. In this section, we'll talk about some of these problems, and how you can solve them.

  • GRIEVANCE: You can file a grievance if you get poor customer service from your plan.
  • EXCEPTION: You can ask for an exception if your plan won't pay for one of your prescriptions, or if your plan asks you to pay more than you can afford.
  • APPEAL: You can make an appeal if you ask your plan for an exception to cover a drug or lower your costs and the plan says no.

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