Glossary
Reconsideration
An appeal-level review — Level 1 in Medicare Advantage and Part D, or Level 2 in Original Medicare (handled by a Qualified Independent Contractor).
Also known as: Level 2 Medicare appeal, MA Level 1 appeal
Quick answer
In Original Medicare, a Reconsideration is the Level 2 appeal conducted by a Qualified Independent Contractor (QIC) after an unfavorable Redetermination. In Medicare Advantage and Part D, Reconsideration is the Level 1 appeal — filed with the plan after an unfavorable coverage decision. CMS Form 20033 is used for Original Medicare reconsiderations.
Why it matters
Reconsideration is often where independent review begins, separating the appeal from the entity that issued the denial.
Why this matters at age 65
Knowing which 'Reconsideration' applies (Original Medicare Level 2 vs MA/Part D Level 1) prevents filing in the wrong system.
When you'll encounter it
After an unfavorable Redetermination (Original Medicare) or an unfavorable coverage decision (MA/Part D).
Impact on Medicare
QIC review at Level 2.
Impact on TRICARE For Life
TFL secondary processes follow Medicare's resolution.
Impact on Medicare Advantage
First appeal level inside the plan.
Common misconceptions
- "Reconsideration just gets the same decision." — Independent review entities reverse a meaningful share of plan denials, especially when clinical documentation is added.
Common mistakes to avoid
- Filing the QIC reconsideration with the MAC instead of the QIC named on the redetermination notice.
- Skipping the 60- or 180-day deadlines printed on the notice.
What should I do?
- 1Follow the address and deadline on the prior-level decision letter exactly.
- 2Submit new clinical evidence — adding nothing rarely changes the outcome.
- 3Track the case and follow up if no decision arrives within statutory timeframes.
Continue learning
— suggested by the knowledge graph- Common mistakes retired military make at 65 — and how to avoid themThe most expensive errors retired service members and spouses make during the Medicare and TFL transition, and the simple fixes for each.
- What is Medicare? A complete overview for retired militaryA plain-English, handbook-grounded overview of the federal health insurance program for people 65 and older, written specifically for retired service members and their families.
- Understanding Original Medicare (Parts A & B) for veteransExactly what Part A and Part B cover, what they cost in 2026, and why both are required to keep TRICARE For Life.
- Medicare Advantage for veterans: when it makes sense and when it doesn'tCarrier-neutral education on Medicare Advantage (Part C) for retired military — including how MA changes the role of TFL.
- Appointment of RepresentativeA signed form (CMS-1696) that authorizes another person — family member, attorney, or advocate — to file or pursue a Medicare appeal on your behalf.
- Coverage DecisionA formal decision by a Medicare Advantage or Part D plan about whether — and how — it will cover a service, item, or prescription.
- Medicare AppealThe five-level Medicare appeals process — Redetermination, Reconsideration (QIC), Administrative Law Judge, Medicare Appeals Council, and federal court review.
- Medicare Part C (Medicare Advantage)An optional, all-in-one alternative way to get your Medicare benefits — delivered through a private plan instead of through Original Medicare.
- Prescription Drug ExceptionA request asking a Part D or MA-PD plan to cover a non-formulary drug, lower the tier, or waive a quantity limit — based on medical need.
- Prior Authorization AppealAn appeal of a denial that occurred when a plan refused to pre-approve a service, procedure, or drug.
- Medicare denied a service. Can I appeal?Yes. The first level for Original Medicare is a Redetermination filed with the Medicare Administrative Contractor (MAC) within 120 days of the denial notice (MSN).
- TFL denied a claim. How do I appeal?WPS handles TFL appeals. File a written reconsideration with WPS within 90 days of the denial. Include the Medicare EOB, the WPS denial, and any supporting medical records.
- What do I do if my Medicare claim is denied?Read the MSN denial reason, gather supporting records, and file a Redetermination with the Medicare Administrative Contractor within 120 days.
- Do I appeal to Medicare or to TFL?Appeal to whichever payer issued the denial. If Medicare denied, appeal Medicare. If WPS denied TFL's share, appeal to WPS.
Related glossary terms
Related Official Resources
Continue learning straight from the source. Every link below goes to an official government or DoD resource.
Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.