Medicare 2026

Your Skilled Nursing or Home Health Care Is Ending: How the Fast Appeal Works

If you or someone you love is getting skilled nursing, home health, hospice, or outpatient rehabilitation care through Medicare, there may come a day when the provider says the Medicare-covered portion is about to end. That can feel abrupt, especially if recovery is still in progress. The good news: Medicare has a built-in way to challenge that decision quickly, and it is free to use. Here is how it works and what to watch for.

The notice that starts the clock

Skilled nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities (CORFs), and hospices are required to give you a Notice of Medicare Non-Coverage, also known by its form number, CMS-10123. By federal rule, you should get it at least two calendar days before Medicare-covered services end. If care is not provided every day, you should get it no later than the second-to-last day of service. CMS points out that this is a two-day rule, not a 48-hour rule — the clock runs in calendar days.

The NOMNC is used in both Original Medicare and Medicare Advantage. For Medicare Advantage enrollees, the federal "fast-track" appeal process covers skilled nursing facilities, home health agencies, and CORFs. Wherever it is used, the notice must clearly state the date your coverage will end and explain your right to a fast appeal.

If you ever feel pressured to sign something you do not understand, slow down. Signing the notice is not agreement that coverage should end — it is just confirmation that you received it.

How to request a fast appeal

To get a timely fast appeal, follow the instructions printed on your NOMNC and contact the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) no later than noon of the day before the coverage end date listed on the notice. The notice itself tells you that services continue during the appeal — an important protection while the review is underway.

Once you contact the QIO, your provider is required to give you a Detailed Explanation of Non-Coverage by the end of that day. This document spells out why the provider or plan believes Medicare should stop paying. The QIO uses it, along with your medical records, to make a decision.

According to Medicare.gov, the QIO decides by close of business the day after it gets the information it needs. The NOMNC adds that the decision generally comes no later than two days after the coverage end date. For people enrolled in a Medicare health plan, the decision is generally made by that date.

A key point many families miss: in Original Medicare, the provider carries the burden of proving that ending coverage is correct. In Medicare Advantage, the plan does. You do not have to prove that you still need the care — they have to prove you no longer meet Medicare's coverage rules. And if the QIO finds that you did not receive a valid notice to begin with, your coverage continues until at least two days after a valid notice is delivered.

What happens after the QIO decides

If the QIO agrees that services should end, you are not responsible for services provided before the coverage end date on the NOMNC. You may, however, have to pay for services received after that date if you choose to continue care out of pocket.

If you miss the noon deadline, you can still ask the QIO for a decision. It will be made as soon as possible, but without the usual tight time frame and without the financial protection of a timely request. If you are in Medicare Advantage, Medicare.gov notes that you can instead ask your plan for a fast reconsideration — but in that case, services are covered only if the decision comes out in your favor.

If you disagree with the QIO's decision in Original Medicare, you have another step: you can ask a Qualified Independent Contractor (QIC) for an expedited reconsideration, in writing or by phone, by noon of the calendar day after you are notified of the QIO's decision. The QIC generally must decide within 72 hours after receiving your request and the records it needs.

Practical tips for families

• Read the NOMNC the moment it arrives. Note the coverage end date and the QIO phone number.
• Call the QIO early — do not wait for the noon deadline on the final day.
• Ask your provider for a copy of recent therapy notes, nursing assessments, and physician orders. These often support the case for continued coverage.
• If you are a caregiver acting on someone's behalf, be ready to explain your relationship; a representative can file the appeal.
• Keep a written log of dates, times, and names of everyone you speak with.

A quick word on coverage choices

Some readers reviewing an appeal start wondering whether their overall coverage still fits their needs. Original Medicare paired with a Medigap policy and a stand-alone Part D plan, and Medicare Advantage, each come with trade-offs around networks, cost-sharing, extra benefits, and appeal paths. Neither is "better" for everyone — it depends on your health, budget, and preferences.

If you have Medicaid or qualify for Extra Help, you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan or to switch stand-alone plans. Full-benefit dual-eligible individuals can join an integrated D-SNP in any month.

For 2027, the Part D out-of-pocket cap is $2,400, and no Part D plan may charge a deductible higher than $700. The Part D base beneficiary premium — used in calculating the late-enrollment penalty — is $41.33. Annual Enrollment for 2027 runs October 15 – December 7, 2026, with changes taking effect January 1, 2027. The Social Security Administration announced a 3.6 percent COLA for benefits payable beginning January 2027. The 2027 Part B standard premium, deductible, and IRMAA income brackets have not yet been announced; CMS releases those figures in the fall.

Where can you get help with Medicare questions?

For official information and to confirm details for your situation, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week. TTY users can call 1-877-486-2048. Keep your NOMNC handy when you call — it contains the specific contact information for the QIO handling your appeal.