If you have Original Medicare and disagree with a coverage or payment decision, or the amount of a claim that’s been paid, you can complete and return a Medicare appeal form.

When a doctor, healthcare professional, or medical facility bills Medicare, Medicare assesses the claim and makes payment according to its rules and limits for eligible treatments, items, and services.

Sometimes a claim is denied or only partially paid. This could be an error. You can complete an appeal form to ask Medicare to reconsider its decision.

Medicare must receive appeals in writing. Providing supporting evidence gives you the best chance of winning your appeal.

If you have Original Medicare, Part A and Part B, you will receive a Medicare Summary Notice (MSN) every 4 months.

MSNs will include details relating to:

  • all medical items and services that you have received in the prior 4 months
  • the amount Medicare has paid toward these costs
  • the amount you may owe for these items and services

You will usually have paid your part of the costs at the time you received care.

However, if there are items or services listed on the MSN that Medicare has not covered, it has paid less than expected, or it requires you to make further payment, you can follow the instructions on the back of the MSN to file an appeal or complete and return an appeal form.

Medicare stipulates that all appeals must be filed in writing.

If Medicare denies a claim, the first thing you can do is to contact your medical team to check that they submitted the correct information.

If there has been an error, they should be able to contact Medicare’s claim office with the correct information so Medicare can reassess the decision.

If the initial claim information was correct, there are two ways to lodge an appeal.

Using an MSN to file an appeal

  1. Circle the items on the MSN that you are appealing.
  2. Write a statement detailing why you disagree with the decision.
  3. On the back of the last page of the MSN, you will see a box for appeals. Enter your name, contact telephone number, and Medicare Number (from your Medicare card).
  4. Gather evidence to support your claim. This could be anything that will help Medicare understand why the claim is eligible for payment, such as a medical report or a doctor’s letter.
  5. Take copies of all documents, letters, and statements for your records.
  6. Mail your appeal to Medicare at:
    • Medicare Claims Office
    • c/o Contractor Name
    • Street Address
    • City, ST 12345-6789

Using a Level 1 Appeal form to file an initial appeal

  1. Print and complete the “Medicare Redetermination Request — 1st Level of Appeal” form.
  2. Gather evidence to support your claim. This could be anything that will help Medicare understand why the claim is eligible for payment, such as a medical report or a doctor’s letter.
  3. Take copies of all documents, letters, and statements for your records.
  4. Mail your appeal to Medicare at:
    • Medicare Claims Office
    • c/o Contractor Name
    • Street Address
    • City, ST 12345-6789

Medicare Advantage and Part D drug plan appeals

Private medical insurers administer both Medicare Advantage and Part D prescription drug plans, and their appeals process are different from that of Original Medicare.

You should contact your plan provider to discuss how to lodge an appeal. However, progressing appeals have similar routes to Original Medicare.

There are five levels of appeal. If a person disagrees with a decision at each stage, they may progress to the next level. The stages and how they are reviewed are:

  • Level 1 Appeal: These are reviewed by the Medicare administrative contractor.
  • Level 2 Appeal: These are reviewed by a qualified independent contractor (QIC).
  • Level 3 Appeal: These are reviewed by the Office of Medicare Hearings and Appeals (OMHA). To file an appeal with the OMHA, the claim must be for a minimum dollar amount of $190 in 2025.
  • Level 4 Appeal: These are reviewed by the Medicare Appeals Council.
  • Level 5 Appeal: These are subject to a judicial review in a federal district court. To file a Level 5 appeal, the claim must be for a minimum dollar amount of $1,900 in 2025.

The decision at each level includes instructions on how to proceed to the next, up to the fifth and final level.

Medicare Advantage and Part D drug plan appeals process

Once a person contacts their plan provider to discuss their initial appeal, an Independent Review Entity (IRE) will review Level 2. Levels 3 and onward are the same as Original Medicare.

If a person disagrees with a claim decision, they can file an appeal by filling out the small form on the reverse of the final page of their Medicare Summary Notice (MSN) or by completing the larger form “Medicare Redetermination Request Form — 1st Level of Appeal.”

Individuals should include supporting evidence that shows why Medicare should reconsider its claim denial.

There are five levels of appeal, with the final appeal being considered by the federal district court.

People with Medicare Advantage or Part D prescription drug plans can contact their plan providers to discuss how their initial appeals process works.