Short answer: Original Medicare has five appeal levels: redetermination by the Medicare Administrative Contractor (file within 120 days of receiving the Medicare Summary Notice), reconsideration by a Qualified Independent Contractor, a hearing with the Office of Medicare Hearings and Appeals, the Medicare Appeals Council, and federal court.
- Level 1, redetermination: file within 120 days of receiving the Medicare Summary Notice (receipt is presumed 5 days after the notice date). Decision generally within 60 days.
- Level 2, QIC reconsideration: file within 180 days of the level 1 decision. Decision within 60 days.
- Level 3, OMHA (Administrative Law Judge): file within 60 days; for 2026 the amount in dispute must be at least $200.
- Level 4, Medicare Appeals Council: file within 60 days of the ALJ decision.
- Level 5, federal district court: file within 60 days; for 2026 the amount must be at least $1,960 (claims can be combined).
Late filing is allowed for good cause, such as serious illness or not receiving the notice. Ask the provider for records that support the appeal, and appoint a representative in writing if a family member is helping.
Sources
Medicare.gov: Appeals in Original Medicaremedicare.gov/providers-services/claims-appeals-complaints/appeals/original-medicare42 CFR 405.942 (redetermination time frame)ecfr.gov/current/title-42/section-405.942eCFR 42 CFR 405.942ecfr.gov/api/versioner/v1/full/2026-10-23/title-42.xml?part=405§ion=405.942