Original Medicare denied my claim. How long do I have to appeal, and how fast must they answer?

Health insuranceAppealChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Medicare.gov · Filing an appeal · page text View original ↗

In short

Ask for the first appeal within 120 days of getting the notice.
Medicare counts the notice as received 5 days after its date.
The contractor has 60 days to mail its decision.

What this means

Medicare.gov says you can appeal if Medicare refuses to cover or pay for a service, supply or item, or changes what you pay [1]. The first appeal is called a redetermination. Ask within 120 calendar days of getting the notice. The rule counts the notice as received 5 days after its date, unless there is proof otherwise [2].

After 120 days, the contractor may allow more time if you show good cause. Ask in writing and say why you were late [2]. The contractor mails its decision within 60 calendar days of getting a timely request [3]. New evidence can add up to 14 days each time [3].

Medicare.gov says there are generally 5 levels of appeal. Each decision letter tells you how to go on [1].

Your next step

Count 120 calendar days from the date you receive the notice, which the rule presumes is 5 days after the date on it, and file your request before then [2]. If you are late, ask for more time in writing and say why [2].

Check it yourself

Open Medicare.gov, Filing an appeal, and the two CFR sections in Sources 2 and 3. Your own notice shows its date and how to file: "Don't know yet" for your case.

Where this comes from (3)

[1] Medicare.gov · Filing an appeal · page text · checked 2026-11-06
You can file an appeal if Medicare or your plan refuses to: Cover a health care service, supply, item, or drug you think Medicare should cover. Pay for a health care service, supply, item, or drug you already got. Change the amount you must pay for a health care service, supply, item, or drug … Generally, there are 5 levels of appeals. If you disagree with the decision made at any level of the process, you can usuall…
[2] GovInfo · 42 CFR § 405.942 Time frame for filing a request for a redetermination · (a), (b) · checked 2026-11-06
any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination … the date of receipt of the initial determination will be presumed to be 5 calendar days after the date of the notice of initial determination, unless there is evidence to the contrary … a party shows good cause, the contractor may extend the time frame for filing a request fo…
[3] GovInfo · 42 CFR § 405.950 Time frame for making a redetermination · (a), (b)(3) · checked 2026-11-06
within 60 calendar days of the date the contractor receives a timely filed request for redetermination … If a party submits additional evidence after the request for redetermination is filed, the contractor's 60 calendar day decision-making time frame is extended for up to 14 calendar days for each submission

How we found this

We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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