The four appeal levels
Checked against the current rules on September 24, 2026.
A Medicare enrollment and entitlement denial can move through up to four levels of review. Most cases resolve at the first or second — but knowing the whole ladder helps you understand where your case actually is, and what's next if it keeps going.
Level 1 — Reconsideration
Decided by: Social Security Administration (a different reviewer than the one who made the initial determination).
65 days from the date on the notice — 60 days from when you receive it, plus SSA's standard 5-day mailing presumption. A written request is required.20 CFR 404.909
No fixed decision deadline is stated in the corpus for this level.
Where to send it: Social Security, by mail, fax, or in person at a field office.
Level 2 — Administrative Law Judge (ALJ) hearing
Decided by: An Administrative Law Judge at the Office of Medicare Hearings and Appeals (OMHA).
65 days from receiving the reconsideration decision.42 CFR 405.1014
OMHA sets the specific date and time for your hearing after you file; there's no fixed decision deadline stated in the corpus for this level.
Where to send it: The entity named in the reconsideration decision notice.
Level 3 — Medicare Appeals Council review
Decided by: The Medicare Appeals Council, part of HHS's Departmental Appeals Board.
65 days from the ALJ's or attorney adjudicator's decision.42 CFR 405.1100
No fixed decision deadline is stated in the corpus for this level.
Where to send it: The Departmental Appeals Board, following the instructions printed in the ALJ's decision.
Level 4 — Federal district court
Decided by: A judge in a United States district court.
65 days from the Council's decision.42 CFR 405.1130
Set by the court, the same as any federal civil case.
Where to send it: The United States District Court for the judicial district where you reside.
Questions people ask
- Do I have to go through every level in order?
- Yes — each level is reached only after the one before it.
- What if I miss a deadline?
- Every level with a filing deadline allows a late filing for good cause — a serious illness, a family emergency, or not having received the notice, for example.
Sources — last checked September 24, 2026
- 20 CFR 404.909as of September 24, 2026
- 42 CFR 405.1014as of September 24, 2026
- 42 CFR 405.1100as of September 24, 2026
- 42 CFR 405.1130as of September 24, 2026
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By CaseWhy Appeals editorial. See how this content is produced. Not legal advice. Not affiliated with or endorsed by Medicare, CMS, or any health plan. A product of CaseWhy LLC.
