Appeal deadlines by coverage type

There is no single appeal deadline. It depends on your kind of coverage and on what the clock counts from. This page lists the federal minimums we checked, cited to the Code of Federal Regulations (CFR) and the United States Code (U.S.C.). Your notice, your plan documents or your state may give more time. Check the date on your notice, which controls.

What this means

For job-based plans and individual plans that are not grandfathered, 180 days is a floor: a plan may allow more, never less. Each level also has its own clock, counted from the new decision.

Private coverage

Coverage	First appeal	Next level	Source
Job-based plan under the Employee Retirement Income Security Act (ERISA), self-funded or insured	Internal appeal: at least 180 days after you receive the denial notice. The plan decides in 72 hours (urgent), 30 days (before care) or 60 days (after care); 15 and 30 days at each level if the plan has two levels.	External review (independent reviewer outside the plan): at least four months after you receive the denial or final internal denial. Decision in 45 days, or 72 hours if urgent.	29 CFR 2560.503-1(h)(3)(i), (i)(2); 29 CFR 2590.715-2719(c), (d)
Marketplace or individual plan, not grandfathered	Internal appeal: at least 180 days after you receive the notice. One internal level.	External review: at least four months after the final denial.	45 CFR 147.136(b)(3), (c), (d)
Grandfathered employer plan (in place 23 March 2010)	ERISA claims process: at least 180 days.	No general external review, except certain surprise-billing disputes.	29 CFR 2560.503-1(a); 45 CFR 147.140
State or local government employer plan; church plan	Affordable Care Act appeal rules apply to non-federal government plans; the day count is on your notice. For church plans, enforcement is not confirmed.	External review under the same rules; ask your plan.	45 CFR 146.180; 26 U.S.C. 9815
Federal Employees Health Benefits (FEHB) plan	Ask the carrier in writing within 6 months of the date on the denial notice.	Ask the Office of Personnel Management within 90 days after the carrier’s letter upholding the denial (120 days if the carrier did not respond).	5 CFR 890.105(b), (e)
Short-term plan, sharing ministry, fixed indemnity	The Affordable Care Act appeal rules do not apply. The contract and state law set the deadline. For an employer-sponsored fixed indemnity product, we have not confirmed whether the general federal claims rule applies.	Check your contract and state.	42 U.S.C. 300gg-91(b)(5); 45 CFR 148.220

Public programs

Coverage	First appeal	Next level	Source
Original Medicare	Redetermination: 120 calendar days after you receive the decision (receipt presumed 5 days after the notice date).	Reconsideration, 180 days; then judge hearing, 60 days (at least $200 in 2026); Appeals Council, 60 days; federal court, 60 days (at least $1,960 in 2026; $2,000 for requests filed on or after 1 January 2027).	42 CFR 405.942, 405.962, 405.1002, 405.1102, 405.1130
Medicare Advantage	Reconsideration: 65 days from the date on the notice.	Automatic independent review if the plan upholds; then judge hearing within 60 days.	42 CFR 422.582(b), 422.590
Medicare drug plan (Part D)	Redetermination: 65 days from the date on the notice.	You must request independent review in writing within 65 days.	42 CFR 423.582(b), 423.600(a)
Medicare fast appeals	Hospital discharge: no later than the day you leave. Skilled nursing facility or home health services ending: by noon of the day after you get the notice.	If upheld, ask for a faster second review by noon of the next day.	42 CFR 405.1206, 405.1202, 405.1204
Medicaid (fee for service)	Fair hearing: “a reasonable time, not to exceed 90 days from the date that notice of action is mailed”. The state sets the number.	Per your state.	42 CFR 431.221(d)
Medicaid managed care	Plan appeal: 60 calendar days from the date on the notice.	State fair hearing: 90 to 120 days from the plan’s decision notice.	42 CFR 438.402(c), 438.408(f)
Children’s Health Insurance Program	State process. Managed care plan appeal: 60 days.	External review: 90 to 120 days from the plan’s decision.	42 CFR 457.1120, 457.1260
TRICARE	Reconsideration: postmarked within 90 days of the date on the decision or Explanation of Benefits.	Formal review (60 days, $50 or more); second reconsideration for medical necessity (90 days); hearing (60 days, $300 or more).	32 CFR 199.10
Veterans Affairs	Care decisions: no hard deadline, appeal as soon as you can. Benefit decisions: review or Board appeal within one year of the notice date.	Second clinical appeal; Supplemental Claim with new evidence (can be filed at any time, but file within one year of the decision to keep the claim continuously pursued).	Veterans Affairs decision reviews; 38 CFR 3.2500
Indian Health Service Purchased/Referred Care	30 days after you receive the denial notice.	Two more steps, 30 days each.	42 CFR 136.25
Marketplace eligibility decision	90 days from the date on the eligibility notice.	A state exchange’s decision can go to the federal entity within 30 days.	45 CFR 155.520

What to do

1. Name your coverage with how to find out what kind of plan you have.
2. Find your row and read the “counted from” date. Compare it with the dates on your notice.
3. Put the earliest possible deadline on your calendar, and the date the plan must answer by. Do not wait for the last day.
4. Check urgency. If the care cannot wait, see expedited appeals.

The rule

A group health plan must give a claimant at least 180 days after receiving a denial notice to appeal, and must allow at least four months after receiving a denial to request external review. Source: 29 CFR 2560.503-1(h)(3)(i) and 29 CFR 2590.715-2719(c)(2)(vi).

Watch for

• State rules differ. California gives 6 months after the plan’s written response to your appeal for state review, and Maine 12 months after you receive the insurer’s final decision. See California and Maine.
• “180 days” is for private plans. Original Medicare is 120 days, Medicare Advantage and drug plans 65 days, and Medicaid, TRICARE and Veterans Affairs differ again.
• Late is not always final. Some programs accept a late appeal for good cause; see how deadlines are counted.

What next

• Learn how days are counted, and what to do after a missed date: how deadlines are counted.
• Learn your rights at each step: your rights when a health plan says no.
• Go to the topic page, know your deadlines.
• Turn the date on your notice into the dates you and the plan each have to meet with the deadline calculator.