Public programs
Medicare appeals: the five levels
Original Medicare claim appeals move through five levels; Medicare Advantage and Part D have their own first steps.
Key points
- Level 1: redetermination by the Medicare Administrative Contractor — generally request within 120 days of the notice.
- Level 2: reconsideration by a Qualified Independent Contractor — generally within 180 days.
- Level 3: hearing with the Office of Medicare Hearings and Appeals (amount-in-controversy threshold applies).
- Level 4: Medicare Appeals Council review. Level 5: federal district court (threshold applies).
- Medicare Advantage plans start with a plan reconsideration; fast appeals exist for hospital discharge and ending skilled services.
In practice
- Read the Medicare Summary Notice or plan notice for the exact deadline and address.
- For a hospital discharge the client disagrees with, contact the Beneficiary and Family Centered Care QIO quickly.
- Refer clients to their State Health Insurance Assistance Program (SHIP) for free counseling.
Official sources
Educational summary, not legal advice. Deadlines depend on the notice, plan type and state.
Sources checked November 7, 2026. Rules change — confirm with the official source before acting.