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

Health insuranceAppealChecked Nov 5, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: Medicare.gov · Appeals in Original Medicare View original ↗

In short

Original Medicare has 5 appeal levels.
Start with your Medicare Summary Notice (MSN). Circle what you disagree with.
First step: ask within 120 days after you get the notice.

What this means

Medicare.gov says Original Medicare has 5 levels of appeal. Each decision letter tells you how to go to the next level [1]. You start with your Medicare Summary Notice (MSN). File by the date shown on it [1].

The time limits are [2][3][4][5][6]: • Level 1, a new look by the Medicare contractor ("redetermination"): within 120 days after you get the notice. • Level 2, a review by an outside contractor (QIC): within 180 days after you get the Level 1 decision. • Level 3, a hearing with a judge (ALJ): within 60 days after you get the Level 2 decision. In 2026 the amount in dispute must be at least $200 [7]. • Level 4, the Medicare Appeals Council: within 60 days after you get the judge's decision. • Level 5, federal court: within 60 days after you get the Council's decision. In 2026 the amount must be at least $1,960 [7].

All of these are calendar days. The rules assume you got each notice 5 days after its date, unless you show otherwise [2]. Missed a deadline? You can ask in writing for more time and explain your "good cause," like a serious illness [2]. Medicare.gov says Level 1 decisions usually come within 60 days [1].

Your next step

Circle the denied item on your MSN, write why you disagree, and mail it to the address on the MSN (or use the Redetermination Request Form).

Deadline: 120 calendar days after you receive the MSN.

Check it yourself

Look at the date and the "appeal by" date on your MSN. Read the Medicare.gov page above for the forms. The 2026 dollar amounts change each year; a CMS notice for 2027 was published on 2026-09-16 — the 2027 amounts were not checked here ("Don't know yet").

Where this comes from (7)

[1] Medicare.gov · Appeals in Original Medicare · checked 2026-11-05
There are 5 levels of appeal. If you disagree with the decision made at any level of the process, you can usually go to the next level. At each level you'll get a decision letter with instructions on how to move to the next level. … Start your appeal by looking at your " Medicare Summary Notice (MSN). You must file your appeal by the date in the MSN. … You'll generally get a decision from the Medicare Administrative …
[2] eCFR · 42 CFR 405.942 · § 405.942(a)-(b) · checked 2026-11-05
any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination. ( 1 ) For purposes of this section, 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. … If the 120 calendar day period in which to file a requ…
[3] eCFR · 42 CFR 405.962 · § 405.962(a) · checked 2026-11-05
any request for a reconsideration must be filed within 180 calendar days from the date the party receives the notice of the redetermination.
[4] eCFR · 42 CFR 405.1002 · § 405.1002(a)(1)-(2) · checked 2026-11-05
( 1 ) The party files a written request for an ALJ hearing within 60 calendar days after receipt of the notice of the QIC's reconsideration. ( 2 ) The party meets the amount in controversy requirements of § 405.1006 .
[5] eCFR · 42 CFR 405.1102 · § 405.1102(a)(1) · checked 2026-11-05
A party to a decision or dismissal issued by an ALJ or attorney adjudicator may request a Council review if the party files a written request for a Council review within 60 calendar days after receipt of the ALJ's or attorney adjudicator's decision or dismissal.
[6] eCFR · 42 CFR 405.1130 · § 405.1130 · checked 2026-11-05
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.
[7] Federal Register · CMS notice 2025-21879 (Dec. 4, 2025) · Amount in Controversy Threshold Amounts for Calendar Year 2026 · checked 2026-11-05
The calendar year 2026 AIC threshold amounts are $200 for ALJ hearings and $1,960 for judicial review.

How we found this

We matched your question to 7 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-05.

What we don’t know yet

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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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