Medicare Advantage has five appeal levels. Most people stop at one.

Medicare Advantage plans deny about 6% of all prior-auth requests, according to KFF's most recent analysis. That's 35 million decisions in 2022, with about 2 million denials. Of those, fewer than 12% were ever appealed. Of those that were appealed, 83% were reversed.

Read that again. When Medicare Advantage denials get appealed, they get reversed more than four times out of five. The reason almost no one wins is that almost no one tries.

Medicare gives you five levels. Most carrier websites only mention two.

Level 1 — Plan reconsideration. Internal review by the plan itself. Standard denials get 30 days; expedited cases get 72 hours. Reverses about 41%.

Level 2 — IRE (Maximus). An independent contractor reviews the case. CMS itself runs this layer. Higher reversal rate than level 1 because Maximus isn't paid by the plan.

Level 3 — Administrative Law Judge (ALJ). A federal judge hears the case. Hearings are by phone. This is where complex denials win — the ALJ has authority to weigh medical evidence the plan ignored.

Level 4 — Medicare Appeals Council. Reviews ALJ decisions for procedural error or law-of-the-case issues. Rare to reach.

Level 5 — Federal District Court. Real lawsuit territory. Almost nobody gets here, and almost nobody needs to.

Each level has a deadline (60 days for level 2, 60 days for level 3) and a specific minimum dollar threshold (level 3 requires the case to be worth at least $190 in 2026). Missing a deadline kills the case. Missing the threshold means consolidating multiple denials.

The single biggest mistake we see: people get a level 1 denial, sigh, and stop. The level 2 timer starts immediately. Sixty days later, the right to appeal expires and the denial becomes final.

If you have a Medicare Advantage denial, the right move is to start the level 2 paperwork the day the level 1 denial arrives. We do that for you.