Medicare Appeal Filing Deadlines: When to File

What deadline applies to Original Medicare appeals?

For Original Medicare, the first appeal level is called a redetermination. This is a request for a Medicare Administrative Contractor to review a coverage or payment decision shown on a Medicare Summary Notice or other initial claim decision.

Level 1, redetermination: Generally due within 120 days from the date you receive the initial claim determination.
Level 2, reconsideration: Generally due within 180 days from the date you receive the redetermination decision.

Your Medicare Summary Notice or decision letter should list the specific filing date and instructions. Use the date in the notice when available.

What are the Medicare Advantage and Part D appeal deadlines?

For Medicare Advantage and Medicare drug plans, the first appeal deadline is generally tied to the plan’s denial notice.

Medicare Advantage initial appeal: You, your representative, or your doctor or health care provider generally must file within 65 days from the date on the plan’s initial denial notice.
Part D initial appeal: You, your representative, or your prescriber generally must ask for an appeal within 65 days from the date on the plan’s initial denial notice.
Part D Level 2 reconsideration: If the plan upholds its denial, you generally have 60 days to file a standard reconsideration with the Part D Independent Review Entity.

Medicare Advantage plans and Part D plans must give written instructions explaining how to appeal. Follow the address, form, and deadline listed in the notice.

What are the deadlines for higher Medicare appeal levels?

After the first and second appeal levels, Medicare appeals may move to the Office of Medicare Hearings and Appeals, the Medicare Appeals Council, and, in some cases, federal court.

Administrative Law Judge or attorney adjudicator review: Generally due within 60 days after receiving the reconsideration decision.
Medicare Appeals Council review: Generally due within 60 days after receiving the OMHA decision or dismissal.
Federal District Court review: Generally due within 60 days after receiving the Medicare Appeals Council decision or related notice.

Higher appeal levels may also require the disputed amount to meet a minimum amount in controversy. That amount can change by year, so check the notice before filing.

Are fast appeal deadlines different?

Yes. Fast appeals have shorter deadlines and usually apply when coverage is ending or a delay could affect your health. The exact deadline depends on the setting and the notice you receive.

Hospital discharge appeal: Follow the instructions on the Important Message from Medicare, generally no later than the day you are scheduled to be discharged.
Ending covered services in other settings: Follow the Notice of Medicare Non-Coverage, generally no later than noon of the day before the termination date listed on the notice.

If you miss a fast appeal deadline, different rules may apply. The notice should explain your options and possible payment responsibility.

Can you file a Medicare appeal late?

In some situations, yes. Medicare may allow a late appeal if you can show good cause for missing the deadline. Good cause can include circumstances such as illness, disability, an accident, or being given wrong or unclear information about how to file.

If you file late, include a written explanation of why the appeal was not filed on time and provide any supporting documentation you have. A late filing is not automatically accepted, so it is best to file by the deadline whenever possible.

How can you avoid missing a Medicare appeal deadline?

Medicare appeal deadlines are usually measured from the date you receive a notice or from the date printed on a plan denial notice. To stay organized:

Read the entire notice as soon as it arrives.
Write down the filing deadline and appeal level.
Use the form, address, fax number, or online process listed in the notice.
Keep copies of what you send.
Use trackable mail, fax confirmation, or online confirmation when available.
Ask your provider, prescriber, or representative for supporting information before the deadline.

If the notice and general Medicare rules appear to conflict, follow the instructions in the notice or contact Medicare or the plan for clarification.

Our Process

From First Meeting to Medicare Enrollment

We begin by helping you understand how Medicare works and how the different pieces fit together. We walk through Original Medicare, Parts A and B, Medicare Advantage, Medicare Supplement insurance, and Part D prescription drug coverage, including how formularies, drug tiers, and plan rules can affect your costs.

We also explain dental, vision, and hearing coverage, along with other products that may help fill gaps in your healthcare plan. Depending on your needs, that may include short-term in-home healthcare coverage, hospital indemnity insurance, or coverage designed to provide additional financial support following a cancer diagnosis, heart attack, or stroke.

Once you understand the landscape, we move into the planning stage. That is when we review your doctors, hospitals, prescription drugs, current coverage, and other personal details so we can begin evaluating the Medicare plan options that fit your situation.

Discovery Meeting

We collect information about your doctors, hospitals, prescription drugs, current coverage, and other important details, then discuss your unique situation and priorities. Start your secure Medicare profile.

Create Your Strategy

We review the information gathered during discovery and develop a Medicare claiming and coverage strategy tailored to your circumstances.

Plan Enrollment

Once you are comfortable with the strategy, we help coordinate the appropriate enrollment steps and timing.

Annual Reviews

Medicare plans, costs, formularies, provider networks, and personal circumstances can change. We conduct annual reviews to help determine whether your current coverage still fits.

Request Medicare Planning Information

Official Sources

Appeals in Original Medicare | Medicare
Verifies Original Medicare appeal levels, use of the Medicare Summary Notice, good cause for missed deadlines, and 180-day Level 2 timing.
First Level of Appeal: Redetermination by a Medicare Contractor | CMS
Verifies the 120-day filing deadline for Original Medicare redetermination requests.
Second Level of Appeal: Reconsideration by a Qualified Independent Contractor | CMS
Verifies the 180-day filing deadline for Original Medicare reconsideration requests and related dismissal review timing.
Appeals in Medicare health plans | Medicare
Verifies Medicare Advantage appeal timing, including the 65-day deadline from the plan’s initial denial notice.
Appeals in a Medicare drug plan | Medicare
Verifies Part D appeal timing, including the 65-day initial appeal deadline and later appeal steps.
Fast appeals | Medicare
Verifies special fast appeal deadlines for hospital discharge and termination of covered services.

Journalist Quotes, Key Facts & Citation Resources

Everything you need for editorial reference is below. Use ready-to-quote expert commentary, key facts for reporting, official sources, citation tools, and republication options related to this answer.

Our commitment to journalists: Our goal is to make Senior Healthcare Planning a trusted, independent resource for journalists covering Medicare and retirement planning. We work hard to provide clear, researched answers, detailed explanations, and source citations so you can quickly understand the issue, verify the information, and use it with confidence. Our goal is to make your job easier by delivering a white-glove research experience, with reliable information that is easy to quote, explain, and share with your audience.

Editorial & Publishing Resources

Quote, verify, cite, source, or republish information from this answer.

Expert Answer Key Facts Official Sources