Office of Medicare Hearings and Appeals (OMHA)

You are reading about Level 2 of the appeals process.

Who to Appeal to at Level 2

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Background

The Level 2 claim appeals process differs based on what type of Medicare you have. The tabs above describe what the claim appeals process is for each of the four different kinds of Medicare coverage (Parts A, B, C, and D).

The section below provides background to help you identify which Medicare coverage you have.

Description of the Different Parts of Medicare
Original Medicare (Parts A&B) Parts A & B or “Original Medicare” includes Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B). Hospital insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care. Medical insurance (Part B) helps pay for doctors’ services and many other medical services and supplies that are not covered by hospital insurance.
Medicare Advantage Plan (Part C) Part C is the Medicare Advantage program. Under the Medicare Advantage program (Part C), Medicare Advantage plans are available in many areas. Beneficiaries with Medicare Parts A and B can choose to receive all of their health care services through one of these Medicare Advantage plans under Part C.	$Folder with a label reading 'Health Insurance\Private'$
Medicare Prescription Drug Plan (Part D) Part D is the Medicare Prescription Drug program Prescription drug coverage (Part D) helps pay for certain medications doctors prescribe for treatment. Beneficiaries obtain prescription drugs through Medicare Prescription Drug Plans.

Charts detailing the entire appeals process by type of Medicare:

The links below will enable you to download an Adobe PDF or Microsoft Word (MS Word) file that outlines how the appeals process works for the different parts of Medicare. The charts cover Level 1 to Level 5 of the appeals.

Chart of the appeals process for those with Original Medicare - Parts A & B [PDF - 56KB, DOC - 52KB].
Chart of the appeals process with your Medicare Advantage Plans - Part C [PDF - 56KB, DOC - 44KB].
Chart of the appeals process with your Medicare prescription drug plan - Part D [ PDF - 56KB, DOC - 52KB].

Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare entitlements and IRMAA appeals. OMHA is not responsible for levels 1, 2, 4, and 5 of the appeals process. OMHA provides additional information on other levels of appeals to help you understand the appeals process in a broad context.