How to Appeal a Medicare Advantage Denial
A denied Medicare Advantage claim isn’t final. Here’s the 5-level appeal process, realistic deadlines, and how to file your first-level appeal correctly.
By Boris Sorto, Healthcare Advocate · Updated August 26, 2026
A Medicare Advantage denial can be appealed in up to 5 levels, starting with a reconsideration request to your plan, usually within 65 days of the denial notice. Most appeals that get overturned are resolved at the first or second level, so you don’t need to go all the way to federal court for it to work.
The 5 levels of appeal
| Level | What it is | Typical timeframe |
|---|---|---|
| 1. Reconsideration | Your plan re-reviews its own decision | Plan decides within 30 days (72 hours if expedited) |
| 2. Independent Review Entity (IRE) | An outside reviewer, not affiliated with your plan | ~30 days |
| 3. Administrative Law Judge (ALJ) hearing | A formal hearing, generally for claims above a minimum dollar amount | Varies, often several months |
| 4. Medicare Appeals Council | Reviews the ALJ’s decision | Varies |
| 5. Federal court review | Final level, for claims above a higher minimum amount | Varies |
How to file your first appeal
- Read the denial notice carefully. It states the specific reason for denial and your exact appeal deadline.
- Gather supporting documentation: medical records, provider letters, and anything that addresses the stated reason for denial.
- Write your reconsideration request, addressing the specific denial reason directly, not just restating that you disagree.
- Submit before the deadline, using the method your plan specifies (mail, fax, or online portal).
- Keep copies of everything, including proof of submission and dates.
Deadlines that matter
If your health is at serious risk from waiting for a standard decision, you can request an expedited appeal, which your plan must generally decide within 72 hours. Missing a standard appeal deadline doesn’t always end your options, but it does make the process harder, so treat the date on your denial notice as a hard deadline, not a guideline.
Facing a specific denial right now? Our Claim & Appeal Support service helps you organize documentation and prepare the appeal itself. See also our Humana-specific appeal guide if that’s your plan.
Frequently asked questions
How long do I have to file a Medicare Advantage appeal?
Generally 65 days from the date on your denial notice (the exact number can vary by plan and denial type, so always check the specific deadline printed on your notice).
What’s the difference between a grievance and an appeal?
A grievance is a complaint about service quality, wait times, or how you were treated. It doesn’t ask the plan to reverse a coverage decision. An appeal specifically challenges a denial of coverage or payment.
Can someone else file the appeal for me?
Yes, but the plan needs a signed CMS-1696 Appointment of Representative form on file before anyone besides you can act on your behalf with Medicare or your plan.
Written by Boris Sorto
Bilingual Healthcare Advocate, formerly with Humana’s Medicare operations. More about Boris →