People With Medicare

Step 5 - Review by the Federal Court

If the Medicare Appeals Council rules against you, you may ask the Federal court to review your case.

How much time do I have to request a review?

Check the date on the letter you receive from the Medicare Appeals Council about its decision. You must ask the Federal court to review your case within 60 calendar days of this date.

Who can ask for a review?

You can ask for a review by a federal court yourself, or you can appoint someone to do it for you. Your doctor cannot request a review for you.

At this point, if you have not yet hired a lawyer, it is a good idea to do so.

How do I request a review by a federal court?

You or the person acting for you must ask for review by a Federal court in writing by filing a federal court document called a Complaint. The letter you received from the Medicare Appeals Council about its decision should tell you how to file for review with the Federal court.

To request a Federal court review, you must be appealing at least $1,180. This is the amount you would have to pay over the rest of the year if your plan did not cover the drug you need. It is also called the "amount in controversy." You can find this amount in the letter you get from the Medicare Appeals Council about your reconsideration request. Please check the amount to be sure you can ask for a Federal court review.

How long will it take for the Federal court to make a decision?

The Federal Court can take any amount of time to process your request.

After the court reviews my case, what happens next?

Once a federal court has reviewed your case, generally the appeals process is over. However, if the Federal court does not rule in your favor, you may be able to appeal the decision to a federal court of appeals. Ultimately, you could then take it to the Supreme Court of the United States.

Visit Medicare.gov for more information about grievances, exceptions and appeals.