09/01/2026
Access to medically necessary skilled nursing care should not depend on whether someone knows how, or has the support to appeal a denial.
A recent U.S. Department of Health and Human Services Office of Inspector General report found that Medicare Advantage plans overturned 95% of appealed prior-authorization denials for skilled nursing facility admission. Yet, only 18% of denials were appealed.
If you or someone you care about receives a Medicare Advantage denial for skilled nursing or rehabilitation services:
1. Read the denial notice carefully and act quickly, appeal deadlines can be short.
2. Ask the plan and care providers for information about the decision and appeal process.
3. Keep copies of all notices, records, and communications.
4. Contact your local Long-Term Care Ombudsman Program for information and advocacy related to the rights of long-term-care residents.
5. For Medicare coverage and appeal information, contact the Center for Medicare Advocacy at 860-456-7790 or visit www.medicareadvocacy.org.
No resident should be left without needed care because a denial goes unchallenged.
Read the OIG report: https://oig.hhs.gov/reports/all/2026/medicare-advantage-organizations-overturned-nearly-all-appealed-prior-authorization-denials-for-skilled-nursing-facility-admission-raising-concerns-about-initial-denials/
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