Office of Medicare Hearings and Appeals (OMHA)

Level 1 Appeals

Level 1 is the start of the claim appeals process. Level 1 appeals differ based on what Part of Medicare you want to appeal.

Learn more about the appeals process for each Part of Medicare:

You are at Level 1 Appeals
Select any level for more information.

Medicare Parts

Description of Medicare Parts

Parts A&B
Original Medicare:

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.

Part C:
Medicare Advantage Plan
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Part C is the Medicare Advantage Plan 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.

Part D:
Medicare Prescription Drug Plan

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.

Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare eligibility and Part B premium 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.