Original Medicare denied my claim. What are the appeal levels and deadlines?

Health insuranceAppealChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Medicare.gov · Original Medicare appeals · Level 1 (rows mc-msn, mc-l1-what) View original ↗

In short

Start with your Medicare Summary Notice.
Level 1 is due by the date on that notice.
There are five levels if you keep getting a no.

What this means

Start with your Medicare Summary Notice (MSN). File your appeal by the date in the MSN. If you miss it, you may still appeal if you show good cause [1]. • Level 1 — the Medicare contractor (MAC): You have 120 days from when you get the first decision. Medicare assumes you got the notice 5 days after its date [2]. Put in your name, address and Medicare Number. List the items or services and dates. Say why they should be covered. Add anything that helps, like a doctor's note [1]. • Level 2 — an independent contractor (QIC): You have 180 days after the Level 1 letter or MSN. The QIC decides within 60 days [3]. • Level 3 — a hearing with a judge (OMHA): You have 60 days after the Level 2 decision. In 2026 the amount in dispute must be at least $200 [4]. • Level 4 — the Medicare Appeals Council: You have 60 days after the Level 3 decision [5]. • Level 5 — federal court: You have 60 days after the Council's decision. In 2026 the amount must be at least $1,960 [6].

Your next step

Find the appeal date printed on your MSN and file Level 1 by then [1].

Check it yourself

Open Medicare.gov's "Original Medicare appeals" page and read Level 1 and Level 2. Your MSN shows your own deadline and where to send the appeal.

Where this comes from (6)

[1] Medicare.gov · Original Medicare appeals · Level 1 (rows mc-msn, mc-l1-what) · checked 2026-11-06
Start your appeal by looking at your "Medicare Summary Notice (MSN). You must file your appeal by the date in the MSN. If you miss the deadline for appealing, you may still file an appeal and get a decision if you can show good cause for missing the deadline … Your appeal must include: Your name, address, and the Medicare Number on your Medicare card … List the specific items and/or services and dates you're filing a…
[2] CMS · First Level of Appeal: Redetermination (row mc-l1) · checked 2026-11-06
The appellant … has 120 days from the date of receipt of the initial claim determination to file a redetermination request. The notice of initial determination is presumed to be received 5 calendar days after the date of the notice … Generally, the MAC will send its decision
[3] Medicare.gov · Level 2 (row mc-l2) · checked 2026-11-06
You have 180 days after you get the MAC's decision letter or an MSN to ask for a level 2 appeal … The QIC will send you a decision within 60 days after the QIC gets your appeal request.
[4] CMS · Third Level of Appeal (row mc-l3) · checked 2026-11-06
A request for an ALJ hearing must be filed with OMHA within 60 days of receipt of the reconsideration decision. … For calendar year 2026 the amount in controversy is $200.
[5] CMS · Fourth Level of Appeal (row mc-l4) · checked 2026-11-06
A request for Council review must be filed with the Council … within 60 days of receipt of the notice of OMHA's decision or dismissal.
[6] CMS · Fifth Level of Appeal (row mc-l5) · checked 2026-11-06
A party may file an action in a Federal district court within 60 calendar days after the date it receives notice of the Council's decision. … For calendar year 2026, the amount in controversy threshold is $1,960.

How we found this

We matched your question to 6 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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