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Office of Medicare Hearings and Appeals (OMHA)

Charts of the Appeals Process

The appeals process differs in Level 1 and Level 2 based on what type of Medicare you have. The downloadable PDF and Microsoft Word Document (DOC) files below contain an overview of the appeals process based on type of Medicare coverage.

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  • Original Medicare Appeals (Parts A & B) Process [PDF - 56KB, DOC - 52KB].  Medicare provides this coverage for hospital care, physician visits and other out-patient services. You may have a card that says “Part A” and “Part B”. A decision about your coverage was initially made by a claims contractor for Medicare.
  • Medicare Advantage (Plan C) Appeals Process [PDF - 56KB, DOC - 44KB].  A private insurance company handles your medical care coverage. Generally, you must see physicians in the plan. A decision about your coverage was initially made by this private company.
  • Medicare Drug Plan (Plan D) Appeals Process [ PDF - 56KB, DOC - 52KB].  This chart gives you an overview of the appeals process if you want to appeal a decision made about your drug coverage.

For more detailed information on the differences in the appeals process for each type of Medicare, please see Level 1 appeals.