How long do I have to appeal a Medicare Advantage denial?

For a Medicare Advantage Level 1 reconsideration, generally 60 days from the date on your denial notice. If you are past it, ask for good cause and explain why. Always confirm the deadline printed on your own notice.

What are the levels of a Medicare Advantage appeal?

Five levels: 1) Plan reconsideration, 2) Independent Review Entity (IRE), 3) Administrative Law Judge (OMHA/ALJ, $200 minimum in 2026), 4) Medicare Appeals Council, 5) Federal District Court ($1,960 minimum in 2026). If a level denies, you move to the next.

Medicare Advantage Denial Appeal Letter Builder (Free, 2026)

~13%

of Medicare Advantage prior-auth denials were wrongly denied (federal audit)

over 50%

of appeals that are actually filed get overturned

under 1%

of denied claims are ever appealed — most people just give up

Build your appeal letter

Fill in what you can from your denial notice. Brackets [like this] in the letter are spots for you (or your doctor) to add specifics. Leave a field blank and the bracket stays as a reminder.

Your full name

Member ID (from your plan card)

Plan / insurance company name

Date on your denial notice

What was denied?

Reason the plan gave

How urgent is this?

Your deadline to file Level 1

—

Enter your denial date to see your file-by date (60 days).

Your appeal letter — review it, fill any [brackets], then copy or print:

Before you send: attach a copy of your denial notice and any supporting note from your doctor (this is what wins appeals). Send it the way your notice says — most plans take it by mail, fax, or their member portal. Keep a copy and proof of the send date. This is a self-help template, not legal or medical advice — verify every deadline on your actual denial notice, and a free SHIP counselor or your licensed agent can review it with you at no cost.

📋 Want the full printable Medicare Appeal Kit?

A plain-English walkthrough of all 5 appeal levels, every 2026 deadline, what to attach at each stage, and ready-to-edit letters for redetermination, expedited, and Part D drug appeals — so you (or someone you're helping) never miss a step.

Get the free Appeal Kit PDF →

The 5 levels of a Medicare Advantage appeal (2026)

If a level says no, you move up to the next one. Most cases are won at Level 1 or 2 — but the right to keep going protects you.

Level 1 — Plan Reconsideration

You ask your plan to look again. File within 60 days of the date on your denial notice (ask for "good cause" if you're late). Standard decision: ~30 days for a service, ~60 for a payment. Expedited: 72 hours if waiting could harm your health. This is the letter this tool builds.

Level 2 — Independent Review Entity (IRE)

If Level 1 is denied, your plan must automatically forward your case to an outside reviewer (the Part C IRE, C2C Innovative Solutions, as of May 1, 2026). 30 days standard / 72 hours expedited.

Level 3 — Administrative Law Judge (OMHA/ALJ)

Request within 60 days of the IRE decision. In 2026 your case must be worth at least $200 to reach this level.

Level 4 — Medicare Appeals Council

Request within 60 days of the ALJ decision.

Level 5 — Federal District Court

Request within 60 days of the Council decision. In 2026 the amount in dispute must be at least $1,960.

Frequently asked questions

Does this cost anything? Is my information safe?

It's free, and your information never leaves your device — the letter is built right in your browser, with nothing sent to or saved by us. Levels 1 and 2 are free to file; only the higher levels have a minimum dollar amount.

How long do I have to appeal?

For a Medicare Advantage Level 1 reconsideration, generally 60 days from the date on your denial notice. If you're past it, ask for "good cause" and explain why. Always confirm the deadline printed on your own notice.

What actually makes an appeal win?

A short, specific letter plus a supporting note from your doctor explaining why the service is needed — and pointing out that most denials are paperwork or coverage-rule issues, not medical ones. Attach your denial notice and any records.

Should I ask for an expedited (fast) appeal?

Choose expedited only if waiting the standard time could seriously jeopardize your health — then the plan must decide within 72 hours. For most billing/payment disputes, standard is appropriate.