Appeal deadlines by plan type
The clock starts on the date printed on your denial letter. Your plan may give you longer - these are the federal minimums.
| Plan type | Internal appeal | Source |
|---|---|---|
| PPO (commercial / employer) | 180 days | ACA internal-appeal rule (29 CFR 2560.503-1) |
| HMO (commercial / employer) | 180 days | ACA internal-appeal rule (29 CFR 2560.503-1) |
| EPO | 180 days | ACA internal-appeal rule (29 CFR 2560.503-1) |
| POS | 180 days | ACA internal-appeal rule (29 CFR 2560.503-1) |
| ACA Marketplace plan | 180 days | 45 CFR 147.136 - ACA internal claims and appeals |
| Employer self-funded (ERISA) | 180 days | ERISA / DOL claims regulation (29 CFR 2560.503-1) |
| Medicare (Original / Part A & B) | 120 days | Medicare Redetermination - 42 CFR 405.942 |
| Medicaid (managed-care or fee-for-service) | 60 days | 42 CFR 438.402 (managed care) / state Medicaid rules |
PPO (commercial / employer)
Commercial PPOs that are non-grandfathered must give you at least 180 days from the denial notice to file an internal appeal.
HMO (commercial / employer)
Most commercial HMOs must give you at least 180 days from the denial notice. State HMO laws sometimes give you longer.
EPO
Same baseline as PPO/HMO - at least 180 days.
POS
Same baseline as PPO/HMO - at least 180 days.
ACA Marketplace plan
All non-grandfathered marketplace plans must give you 180 days to file the first-level internal appeal.
Employer self-funded (ERISA)
Self-funded employer plans follow the federal ERISA rule: 180 days for the first appeal of a health-benefit denial.
Medicare (Original / Part A & B)
Level 1 (Redetermination by the MAC) must be filed within 120 days of the Medicare Summary Notice. Medicare Advantage and Part D have their own clocks (typically 60 - 65 days).
Medicaid (managed-care or fee-for-service)
Federal floor for managed-care Medicaid is 60 days from the notice. Some states give 90+ days. To keep benefits during the appeal, file within 10 days of the notice.
Calculate your exact date
Enter the date on your letter and your plan type. We'll show the day your appeal must arrive - and when to mail it.
Open the calculatorFrequently asked
Which date does the deadline run from?
The date printed on the denial letter, not when you received it. That's the date insurers and federal regulators use to compute the appeal window.
Are these deadlines the same in every state?
These are the federal floors. State law can be more generous for fully-insured plans (PPO, HMO, EPO, POS sold in your state). Self-funded ERISA employer plans follow the federal floor everywhere.
What about urgent / expedited appeals?
If a delay would seriously jeopardize your health, you can request an expedited appeal. The plan must decide within 72 hours and the filing deadline is the same as a standard appeal.
What about external review?
After you finish the internal appeals, you typically have 4 months to request external review by an Independent Review Organization. Medicare and Medicaid have their own external-review processes.
Informational only - not legal advice. Always defer to the deadline printed on your denial letter or in your plan documents.