How to appeal an Original Medicare denial

With Original Medicare, the first appeal is due by the date on your Medicare Summary Notice, generally 120 days from when you get it. Later levels mostly allow 60 days each, except 180 days for level 2.

Checked 27 September 2026 against cms.gov, federalregister.gov, medicare.gov

Who decides

Original Medicare has five appeal levels, starting with the Medicare contractor that handles claims in your area.

Steps

Level 1, redetermination: ask the Medicare Administrative Contractor by the date on your Medicare Summary Notice, generally 120 days from when you get it. You can use form CMS-20027 or write a letter.
Level 2, reconsideration by a Qualified Independent Contractor: within 180 days of the level 1 decision.
Level 3, hearing with an Administrative Law Judge: within 60 days, if at least $200 is in dispute (2026 amount).
Level 4, Medicare Appeals Council review: within 60 days.
Level 5, federal district court: within 60 days, if at least $1,960 is in dispute (2026 amount).

Deadlines

Step	File within	Decision due
Level 1 redetermination	by the date on your Medicare Summary Notice, generally 120 days from when you get it	usually within 60 days
Level 2 reconsideration	180 days from the level 1 decision	usually within 60 days
Level 3 ALJ hearing	60 days from the level 2 decision ($200 or more in dispute in 2026)
Level 4 Appeals Council	60 days from the level 3 decision
Level 5 federal court	60 days from the level 4 decision ($1,960 or more in dispute in 2026)

Dates are a guide. Count from the date on your notice, or the day you received it where the rule says so, and use any date printed on your notice if it differs. File early and keep proof of when you sent it.

If it is urgent

If waiting could seriously harm your health, ask for an expedited (fast) appeal and have your doctor say it is urgent. For private plans you can ask for an urgent external review at the same time.

Urgent appeals are decided within 72 hours.

Where to get free help

1-800-MEDICARE (1-800-633-4227).
Your State Health Insurance Assistance Program (SHIP) gives free, one-to-one Medicare help: https://www.shiphelp.org/

What to send with your appeal

A copy of the denial notice or Explanation of Benefits.
A letter from your doctor explaining why the care is needed (a letter of medical necessity).
Relevant medical records, test results and notes on treatments already tried.
The pages of your plan documents that support coverage.
Notes of phone calls: date, time, who you spoke to and what they said.
Keep copies of everything, send it in a way you can track, and ask the plan to confirm it arrived.

For Original Medicare you can use form CMS-20027 instead of a letter: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS20027.pdf

Draft an appeal letter for the reason on your notice: not medically necessary, not an emergency, experimental, out of network, no prior authorization, a coding error or another reason.

Quick answers

How long do I have to appeal?: With Original Medicare, the first appeal is due by the date on your Medicare Summary Notice, generally 120 days from when you get it. Later levels mostly allow 60 days each, except 180 days for level 2.
Who decides my appeal?: Original Medicare has five appeal levels, starting with the Medicare contractor that handles claims in your area.
What if my case is urgent?: If waiting could seriously harm your health, ask for an expedited (fast) appeal and have your doctor say it is urgent. For private plans you can ask for an urgent external review at the same time. Urgent appeals are decided within 72 hours.

General information, not legal or medical advice. Rules differ by plan and state, so check the dates and instructions on your own denial notice, and talk to your doctor about the medical side. Free help is available from your state and the contacts listed.

Sources

Ask Appeal My Claim yourself

Enter the date on your denial notice and get an approximate file-by date for each step. Open Appeal My Claim, free, no sign-up.

In Claude or any app that takes MCP connectors, add https://goodturn-mcp.pages.dev/appealmyclaim/mcp and ask: “How long do I have to appeal a original medicare denial?”