Senior reviewing Medicare appeal paperwork
Medicare Appeals

How to Appeal a Denied Medicare Claim — Step-by-Step Guide for 2026

By Margaret Collins
April 6, 2026 2 Min Read
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How to Appeal a Denied Medicare Claim — Step-by-Step Guide (2026)

Don’t accept a Medicare denial. More than half of all appealed claims are reversed — here’s the exact process to get the coverage you paid for.

Every year, Medicare denies over 4 million claims — including many that are completely valid. The vast majority of seniors simply accept the denial, pay out of pocket, or go without care.

What they don’t know: the appeal success rate is over 50%. In some case types, seniors win 60–80% of appeals. The system is designed to be confusing — but the process is straightforward when you know the steps.

The 5 Levels of Medicare Appeal

Medicare has five formal levels of appeal, each escalating to a higher authority. Most cases are resolved at Level 1 or 2.

Level 1: Redetermination
Who reviews it: The same Medicare contractor who made the original decision
Time limit: File within 120 days of the denial
Decision time: 60 days (30 days for fast-track)
How to file: Submit Form CMS-20027 to the address on your Explanation of Benefits (EOB)
Level 2: Reconsideration
Who reviews it: A Qualified Independent Contractor (QIC) — completely separate from Level 1
Time limit: File within 180 days of Level 1 decision
Decision time: 60 days
How to file: Submit Form CMS-20033 to the QIC listed in your Level 1 decision letter
Level 3: Office of Medicare Hearings and Appeals (OMHA)
Who reviews it: An Administrative Law Judge (ALJ) — completely independent
Minimum amount in controversy: $180 in 2026
Time limit: 60 days from Level 2 decision

Step-by-Step: How to File a Level 1 Appeal

1
Find your denial notice — either your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). This contains the exact reason for denial and the address to send your appeal.
2
Get a letter from your doctor explaining why the service was medically necessary. This is the single most important document in your appeal — a physician statement dramatically increases your chances of winning.
3
Complete Form CMS-20027 (free download at CMS.gov). Fill in your Medicare number, the claim details, and a brief explanation of why you believe the claim should be covered.
4
Send it certified mail with return receipt to the address on your MSN or EOB. Keep a copy of everything you send.
5
Follow up after 30 days if you haven’t heard back. Call 1-800-MEDICARE with your appeal reference number.
💡 Free Help Available: Your State Health Insurance Assistance Program (SHIP) provides free, unbiased help with Medicare appeals. SHIP counselors know the system inside-out and can dramatically improve your chances of winning. Call 1-800-MEDICARE to find your local SHIP number.

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Author

Margaret Collins

Margaret Collins is a Senior Health Expert and Certified Medicare Counselor (SHIP) with over 20 years of experience helping older Americans navigate Medicare, Social Security, and senior wellness. She holds a Master of Public Health (MPH) from Johns Hopkins University and has been quoted in AARP, Healthline, and The Wall Street Journal on issues affecting seniors. Margaret is dedicated to making complex health and benefits information accessible, accurate, and actionable for adults 65 and over.

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