How to appeal a Medicare denial: the five levels explained
The redetermination, reconsideration, ALJ hearing, Appeals Council and federal court levels, deadlines at each, and tips that improve your odds.
If Medicare refuses to pay for a service, you have the right to appeal. Many appeals succeed, especially with a supporting letter from your doctor.
Original Medicare appeals
- Redetermination by the Medicare contractor: file within 120 days of the Medicare Summary Notice.
- Reconsideration by a Qualified Independent Contractor: within 180 days.
- Administrative Law Judge hearing: within 60 days, if the amount meets the threshold.
- Medicare Appeals Council review: within 60 days.
- Federal district court: within 60 days, if the amount meets the threshold.
Tips
- Circle the denied items on your Medicare Summary Notice and explain why the care was needed.
- Ask your doctor for a letter of medical necessity.
- Keep copies and note dates.
Fast appeals
If a hospital, nursing facility or home health agency says your coverage is ending, you can request a fast appeal from the Beneficiary and Family Centered Care Quality Improvement Organization. See also observation status rights.
Medicare Advantage and Part D
Plans have their own process starting with a request to the plan, with independent review after. Prior authorization denials are a common reason; see networks and prior authorization.
Questions people ask
How long do I have to appeal?
120 days from the Medicare Summary Notice for the first level.
How many levels are there?
Five.
Does a doctor's letter help?
Yes, a letter of medical necessity often makes the difference.
Can I get a fast appeal?
Yes, when a hospital or facility says your covered services are ending.
Independent educational site. Not affiliated with or endorsed by the U.S. government, the federal Medicare program, or any insurance company. Figures are 2026 amounts published by CMS unless noted; check Medicare.gov for your situation.