Medicare and Medicaid appeal basics
Medicare and Medicaid have their own appeal systems. This page lists the first-level windows and points to official help. It does not replace the notice you received.
General information, not advice about your case. These steps describe what public agencies and consumer groups commonly suggest. They are not legal, medical or insurance advice, and what applies to you depends on your state, plan, insurer and facts. Check your denial notice and plan documents, and consider asking a licensed attorney, your state insurance department, a patient advocate or your doctor before you act. Full disclaimer.
| Program | First appeal | Window | Help |
|---|---|---|---|
| Original Medicare (Parts A/B) | Redetermination by the Medicare contractor named on your Medicare Summary Notice | 120 days from receipt of the initial determination (presumed 5 days after the notice date). Decision generally within 60 days. Level 2 request: 180 days after the level 1 decision. | SHIP (shiphelp.org) |
| Medicare Advantage | Plan reconsideration | 65 days from the date on the plan's denial notice. Standard pre-service decision 30 days, payment 60 days, fast appeal 72 hours; if the plan upholds the denial it is forwarded automatically to an independent review entity. | Your plan, SHIP |
| Medicaid managed care | Plan appeal (one level) | 60 calendar days from the date on the notice. State fair hearing after the plan upholds: not less than 90 and not more than 120 days from its resolution notice. Standard plan decision within 30 days; 72 hours if urgent. | Your state Medicaid agency; legal aid |
Medicare Part D (drug plans) and "fast appeal" rights when services like hospital or nursing facility care are ending have separate rules; start at Medicare.gov's appeals page. Missing a Medicare deadline can sometimes be excused for "good cause," but do not count on it.
Our letter builder is built for health plan and other insurance denials. Medicare and Medicaid usually provide their own request forms; use those, and use our letters only as drafting help.
Related guides
- Prescription drug denied or not covered: exceptions and appeals
- How to file a health insurance internal appeal
- Independent external review: how it works
- State insurance department directory
Sources
- Medicare.gov: Filing an appeal, last verified 2026-10-20
- Medicare.gov: Appeals in Original Medicare, last verified 2026-10-20
- Medicare.gov: Appeals in Medicare health plans, last verified 2026-10-20
- CMS: First Level of Appeal, Redetermination by a Medicare Contractor, last verified 2026-10-20
- CMS: Reconsideration by the Medicare Advantage (Part C) Health Plan, last verified 2026-10-20
- eCFR: 42 CFR 438.402, Medicaid managed care appeals, not re-verified 2026-10-18 (automated check not permitted or not completed)
- MACPAC: Denials and Appeals in Medicaid Managed Care (PDF), last verified 2026-10-20
Page last reviewed October 20, 2026. Rules change; confirm with your notice, plan documents or the agency pages above.