A Medicare denial can be appealed through five levels, and the last one, a federal district court judge, hears only disputes worth $1,960 or more in 2026. On Jan. 1, 2027, that minimum rises to $2,000, under a notice the Centers for Medicare & Medicaid Services published Sept. 16. The minimum for the third level, a hearing before an administrative law judge, stays at $200.
Medicare.gov says there are five levels of appeals and that a person can usually move to the next level after disagreeing with a decision. Each decision letter explains how to reach the next step. The dollar figure that decides whether a case can go further is called the amount in controversy.
A person who received a denial on a hospital stay, a piece of equipment or a Part B claim has two things to weigh: the filing deadline at the current level, and whether the bill is large enough to climb past level three. The Original Medicare levels, deadlines and dollar floors below come from Medicare.gov’s page on appeals in Original Medicare.
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Levels one and two stay with Medicare’s contractors
Level 1 is a redetermination by a Medicare Administrative Contractor, the private company that processes claims for Medicare. Medicare.gov says the appeal must be filed by the date printed on the Medicare Summary Notice. No dollar minimum applies at this level.
Level 2 is a reconsideration by a Qualified Independent Contractor. A person has 180 days after getting the contractor’s decision letter or the notice to file it, and again Medicare.gov lists no minimum dollar amount.
Level three adds a $200 floor and a 60-day limit
Level 3 is a hearing run by the Office of Medicare Hearings and Appeals, decided by an administrative law judge or an attorney adjudicator. The request is due within 60 days of the Qualified Independent Contractor’s decision. For 2026, Medicare.gov says, “the minimum dollar amount is $200.”
CMS’s September notice keeps that figure at $200 for calendar year 2027. A denied claim worth less than $200 does not meet the minimum for a hearing, so the amount at stake decides whether a case can climb past level two.
Levels four and five: the Appeals Council, then a federal judge
Level 4 is review by the Medicare Appeals Council, and a request is due 60 days after the administrative law judge’s decision arrives. Level 5 is judicial review in federal district court, with another 60 days from the Appeals Council’s decision. Medicare.gov states that for 2026 the federal court minimum is $1,960.
The same Medicare.gov appeals page adds that a person may be able to combine claims to reach the amount in controversy. It points to the instructions in the contractor’s level 4 decision letter for how that works.
On Jan. 1, the federal court minimum becomes $2,000
CMS’s notice, “Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2027,” was published in the Federal Register on Sept. 16, 2026. It sets $200 for administrative law judge hearings and $2,000 for judicial review, effective Jan. 1, 2027. The notice was signed by Chyana Woodyard, CMS’s Federal Register liaison, with Administrator Mehmet Oz approving the document.
The notice says the same amounts apply to Medicare Advantage appeals under Part C and to prescription drug plan appeals under Part D. The Medicare contractor First Coast Service Options lists the same figures for appeals filed on or after Jan. 1, 2027. A dispute worth $1,980 clears the 2026 minimum for court but falls short of the $2,000 minimum that applies to appeals filed in 2027.
Plans and drug coverage have their own appeal pages
Medicare.gov says the process varies by coverage type, and it keeps separate pages for Original Medicare, Medicare health plans and Medicare drug plans. The levels and deadlines above are those listed for Original Medicare. What the CMS notice settles for every type is the dollar floor: $200 for a hearing and $2,000 for court in 2027.
Is the denied claim large enough to reach a federal judge, or does it end at level three?
A denial that looks small can still be a wrong charge, and a wrong charge that goes unchallenged past a deadline stays on the bill. The appeal levels run on short clocks, and the 60-day and 180-day limits start when a letter arrives.
“The Medicare Money Bundle” is a 102-page set of all 8 Medicare guides, including Medicare Billing Errors, which covers how to read statements, fix wrong charges and appeal in time. IRMAA Appeal Basics walks through Form SSA-44 step by step, with a filled-in sample, for the Part B surcharge.
Get the Medicare Billing Errors guide and the IRMAA appeal steps in the Medicare Money Bundle →
This article was produced with AI assistance and edited for accuracy against the sources linked above.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
