The 5 Levels of Medicare Appeals

If you disagree with a decision at any level, you generally have 60 days from the date you receive a denial notice to move to the next step.

  1. Redetermination: A review of your claim by the company that handles Medicare claims (the Medicare Contractor).
  2. Reconsideration: A review by a “Qualified Independent Contractor” (QIC) that did not participate in the first level.
  3. Administrative Law Judge (ALJ) Hearing: A hearing before a judge. For 2026, the amount in controversy must be at least $200.
  4. Appeals Council: A review by the Medicare Appeals Council within the Department of Health and Human Services.
  5. Judicial Review: A final review in a U.S. District Court. For 2026, the amount in controversy must be at least $1,960.

Filing Deadlines by Plan Type

Deadlines for the first level of appeal are strict. Missing these windows may result in a permanent loss of your right to appeal that specific claim.

Plan TypeLevel 1 DeadlineWhere to Send the Request
Original Medicare120 Days from Medicare Summary NoticeAddress on your MSN
Medicare Advantage65 Days from denial noticeDirectly to your private plan
Part D (Drug Plan)65 Days from denial noticeDirectly to your drug plan

Expedited (“Fast”) Appeals

If you believe that waiting for a standard 30-day or 60-day decision will seriously jeopardize your health or life, you can request an expedited review.

  • Response Time: Decisions are typically rendered within 72 hours.
  • Provider Termination: If you are in a hospital, skilled nursing facility, or hospice and are being told your covered care is ending, you can request an immediate review from a Quality Improvement Organization (QIO). You must usually file this by noon of the calendar day after you receive the discharge notice.

Appealing the IRMAA Surcharge

If you are a high earner and your 2026 premiums include an IRMAA surcharge, you do not use the standard medical appeals process. Instead, you file an appeal with Social Security.

  • The Form: Use Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event).
  • Grounds for Appeal: You can appeal if you have experienced a qualifying life-changing event (such as retirement or divorce) that significantly reduced your 2025 or 2026 income.
  • Documentation: You must provide proof, such as a termination letter from an employer or a certified death certificate.

Source: Medicare.gov, “How to File an Appeal” (2026 Update); CMS Manual MLN006562 (Parts A & B Appeals Process).