Deadlines

Health Insurance Appeal Deadlines by Plan Type

Written by Debra Butner, RN, CCM, Donna Lee Health
Updated November 2026

Your appeal deadline depends on the type of coverage you have. In short: 65 days for Medicare Advantage, 120 days for Original Medicare, 60 days for Medicaid managed care, and 180 days for most job based and Marketplace plans. The table below shows each deadline, how long the plan has to decide, and what comes next.

Appeal deadlines at a glance

Federal rules. Your state or plan may allow more time, so check your notice.
Plan type	First appeal deadline	Plan decision time	Fast decision	Next level if denied
Medicare Advantage	65 days from the date on the denial notice	30 days for a service, 60 days for a payment, 7 days for a Part B drug	72 hours	Sent automatically to the Independent Review Entity
Original Medicare	120 days after you receive your Medicare Summary Notice	Generally 60 days	Follow the instructions on your notice	Reconsideration by a Qualified Independent Contractor
Medicaid managed care	60 days from the date on the notice. File within 10 days to keep a current service during the appeal	No more than 30 days, set by your state	No more than 72 hours	State fair hearing, requested within 90 to 120 days of the plan decision depending on your state
Job based and Marketplace plans	180 days from the denial	30 days for care not yet received, 60 days for care already received	72 hours for urgent care	External review, requested within 4 months of the final denial

Not sure which deadline is yours?

The free AppealRN builder asks what kind of plan you have and the date on your notice, then shows your deadline and writes your appeal letter.

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How to find and protect your deadline

Figure out your plan type.
Look at your insurance card and the top of the denial notice. Medicare Advantage plans are run by private companies but carry a Medicare logo or name. Medicaid plans usually name your state program. Job based and Marketplace plans name your employer or the exchange.
Find the date on the notice.
Most deadlines start from the date printed on the notice. Original Medicare counts from when you receive the Medicare Summary Notice, and it assumes you got it 5 days after the date on it unless you can show otherwise.
Count the days on a calendar.
These deadlines are in calendar days, so weekends and holidays count. Write the last day on your calendar and set a reminder one week before it.
Check for a shorter deadline that matters to you.
If you have Medicaid and want to keep a service you already get while you appeal, the 10 day window is the one to watch, not the 60 day window.
Ask for a fast decision if your health is at risk.
If waiting could seriously harm your health, ask for an expedited or urgent appeal and have your doctor support the request in writing.
Send early and keep proof.
Do not wait for the last day. Keep copies, use a delivery method that shows the date, and write down every call with the plan.

A closer look at each plan type

Medicare Advantage

The first level is a reconsideration by your plan. If the plan keeps the denial in whole or in part, it must send your case to the Independent Review Entity without you asking. After that, you can ask for a hearing with an Administrative Law Judge within 60 days of receiving the decision if the amount in dispute meets the yearly minimum. Read our full guide to appealing a Medicare Advantage denial.

Original Medicare

The first level is a redetermination by the Medicare contractor that handled the claim. You can use form CMS 20027 or send a signed letter with your name, Medicare number, the dates of service, the items or services you are appealing, and why you disagree. If someone is helping you, include form CMS 1696, the Appointment of Representative form.

Medicaid managed care

You first appeal to your health plan. If the plan keeps the denial, you can ask your state for a fair hearing. Each state sets its own hearing deadline between 90 and 120 days, so read your notice closely.

Job based and Marketplace plans

You have 180 days to file an internal appeal with the plan. If the plan still says no, you can ask for an external review by an independent reviewer within 4 months of the final denial. A standard external review decision is due within 45 days, and an urgent one within 72 hours.

Frequently asked questions

What is the deadline to appeal a health insurance denial?

It depends on your plan type. Medicare Advantage allows 65 days, Original Medicare allows 120 days, Medicaid managed care allows 60 days, and most job based and Marketplace plans allow 180 days. The deadline printed on your own notice is the one to follow.

Do appeal deadlines count weekends and holidays?

Yes. These deadlines are counted in calendar days, so weekends and holidays are included. Send your appeal early so a holiday or mail delay does not cost you.

How long do I have to request an external review?

For job based and Marketplace plans, you have 4 months from the final denial of your internal appeal to request an external review.

How do I keep my Medicaid services during an appeal?

If you want a service you already receive to continue during your appeal, file your appeal within 10 days of the notice and ask for your services to continue.

How fast does an urgent appeal get decided?

Fast or urgent appeals are generally decided within 72 hours for Medicare Advantage, Medicaid managed care, and job based or Marketplace plans when waiting could seriously harm your health.

What if I missed my appeal deadline?

Call the plan right away and ask whether you can still file and explain your reason. Some programs accept late appeals for a good reason, but the plan or agency decides.

Keep reading

Written by Debra Butner, RN, CCM, Donna Lee HealthDebra is a registered nurse and Certified Case Manager with more than 10 years in utilization review, appeals and grievances, and case management. She built AppealRN so patients and families can answer a denial with a clear, organized letter.

Sources

This is educational information, not legal advice. Always check the deadline printed on your own denial notice.