People With Medicare
Step 4 - Review by the Medicare Appeals Council
If the Administrative Law Judge rules against you, you can ask the Medicare Appeals Council to review your case. The Medicare Appeals Council, or MAC, is the part of the Department of Health and Human Services that handles reviews of all Medicare appeals. This is the last review of your appeal that will happen within the Medicare system. If you wish to appeal more, you must go to a federal court.
How much time do I have to request a review?
Check the date of the letter you receive from the Administrative Law Judge about his or her decision. You must ask the Medicare Appeals Council for a review within 60 calendar days of this date.
Who can ask for a review?
You can ask for the review yourself, or you can appoint someone to do it for you. Your doctor cannot request a review for you.
If you would like to appoint someone to do it for you, you and the person you are appointing should submit Medicare's "Appointment of Representative" form with your request for a review.
How do I request a review?
You or the person doing it for you must ask for a Medicare Appeals Council review in writing. You can use the government's review request form. Make sure to send a copy of the Administrative Law Judge's letter with your request. You must also send your plan a copy of your request.
You or the person helping you must submit a written list of the reasons you disagree with the Administrative Law Judge's decision. You can also submit a written explanation of why you believe the decision should be reversed.
How long will it take for the Medicare Appeals Council to make a decision?
The Medicare Appeals Council can take any amount of time to process your request.
After my review, what happens next?
If the Medicare Appeals Council decides in your favor, then you do not need to do anything more.
If the Medicare Appeals Council rules against you, you can ask for the Federal Court to review your case. The Medicare Appeals Council's letter to you about its decision should say how and where to do so.