Guides04 of 04Updated October 19, 2026
If the plan says no again: the independent review.
You don’t have to file anything. When a Medicare Advantage plan keeps its denial, in whole or in part, it must send the case to an independent reviewer that works for Medicare, not for the plan.
- Forwarding
- Automaticwhen the plan keeps its decision, even in part
- The reviewer
- C2CInnovative Solutions, Medicare’s Part C reviewer since May 1, 2026
- It decides in
- 30 daysfor care you’re waiting for; 60 for a bill; 72 hours if fast
01What the plan must do
The plan writes an explanation and sends the whole case file to the reviewer, within the same time it had to decide: 30 days for care you’re waiting for, 60 days for a bill, and within 24 hours of its decision on a fast appeal.
A plan that misses its own deadline is treated as having said no, and the case goes on the same way.
02Who reviews it
Medicare’s Part C independent review entity. Since May 1, 2026 that is C2C Innovative Solutions; cases it received through April 30, 2026 stay with the former reviewer, MAXIMUS Federal Services.
The reviewer sends your parent, and you if you’re their representative, a letter saying it has the case file.
03What you can still add
You can send the reviewer more information about the case. C2C must receive it no later than 10 days after you get its letter. Put your parent’s name and the appeal number on it. A family member, friend, doctor or lawyer can help you write it.
You can also ask for a copy of the case file the plan sent.
04How long it takes
30 days for care you’re waiting for, 60 days for a bill, 7 days for a Part B drug, 72 hours for a fast appeal. In some cases the time can be extended by up to 14 days. If the reviewer reverses the plan, it tells the plan to pay for or provide the care.
05If the reviewer says no too
The next level is a hearing with an administrative law judge at the Office of Medicare Hearings and Appeals.
- You have 60 days to ask. The reviewer’s letter explains how.
- The amount in dispute must be at least $200 in 2026.
- After that come the Medicare Appeals Council and, for $1,960 or more in 2026, a federal district court.
06Sources
Checked against these on October 19, 2026. This guide explains the published rules; it isn’t legal advice. Where your notice says something different, follow the notice.
- 42 CFR 422.590 — Timeframes and responsibility for reconsiderationseCFR
- 42 CFR 422.592 — Reconsideration by an independent entityeCFR
- Appeals in Medicare health plansMedicare.gov
- Reconsideration by Part C Independent Review Entity (IRE)CMS
- Medicare appeals and your rightsC2C Innovative Solutions (Part C IRE)
- Part C organization determination and appeals process (flow chart)CMS
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