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grievance

What is a Medicare grievance?

What is a Medicare grievance?

Enrollees in a Medicare health plan may file a grievance, also known as a complaint, if they are unsatisfied with their treatment by those who administer their Medicare Advantage or Medicare Part D plan. Conversely, an enrollee would file an appeal to complain about a treatment decision or service that is denied coverage.1

A grievance may or may not involve a request for remedial action (as opposed to an appeal, in which the enrollee is specifically asking that a plan decision be overturned).2

Examples of situations in which a Medicare beneficiary might file a grievance include:3

  • Challenges with getting a medical appointment, or long wait times before an appointment is available
  • Medicare plan staff or healthcare providers in the plan’s network were rude or disrespectful to the enrollee.

The Medicare grievance process is only used by Medicare enrollees and their representatives/caregivers. Healthcare providers use a different complaint/dispute resolution process.2

Footnotes
  1. ”Filing a complaint” Medicare.gov. Accessed July 1, 2025 ⤶
  2. ”Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance” Centers for Medicare & Medicaid Services. Nov. 18, 2024 ⤶ ⤶
  3. ”Grievances” Centers for Medicare & Medicaid Services. Accessed July 1, 2025 ⤶

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