Office of Medicare Hearings and Appeals (OMHA)
Level 1 Appeal: Medicare Prescription Drug Plan (Part D)
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:
Select any level for more information.
You may file an appeal if you are in a Medicare Prescription Drug Plan and you have received a coverage determination from your drug plan sponsor with which you do not agree.
How to Request an Appeal
(i.e., "request for redetermination")
- At Level 1, your appeal is called a request for redetermination by your prescription drug plan.
- You must file your appeal in writing within 60 days, unless your drug plan accepts requests by telephone.
- Contact your Medicare Prescription Drug Plan or check your plan materials about the appropriate process for submitting a request for redetermination.
|When You Will Get a Response|
- Once your drug plan sponsor has received your request, it has seven (7) days (standard request) to notify you of its decision.
- If your prescription drug plan sponsor is unable to complete its decision within the required time frame, it is required to forward your appeal to Level 2.
|Special Circumstances for Expedited Review||Your request for redetermination may be expedited if your drug plan determines or your doctor tells your plan that your health will be seriously jeopardized by waiting for a standard decision. For an expedited redetermination, the plan has 72 hours to notify you of its decision.|
Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare entitlements 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.