Is the 180-day appeal window the same for Medicare?

No. Original Medicare generally uses the deadline printed on the Medicare Summary Notice for a redetermination — often 120 days from receipt of the initial determination. Medicare.gov currently instructs Medicare Advantage and Part D enrollees to file a Level 1 appeal within 65 days from the date on the initial denial notice. ERISA 180-day rules do not control a Medicare case.

How long do I have after an internal appeal to request external review?

Healthcare.gov states that you must file a written external-review request within four months after the date you receive the insurer's notice or final determination that the claim was denied. Your final internal-appeal letter should tell you how to request external review. State and federal tracks differ; follow the notice.

What if my denial letter lists fewer than 180 days?

Keep the letter. For many ACA and ERISA health claims, 180 days is a federal floor, not a suggestion. File by the earlier of (1) the date on the notice if it is longer, or (2) the federal or program clock that actually applies to your plan type. If the notice is shorter than the federal floor for that plan type, note that mismatch in the appeal and still file as soon as you can. Confirm the plan type on your Summary Plan Description or Marketplace documents.

Does the clock start when I received the letter or when it was dated?

It depends on the program. Healthcare.gov's 180-day internal-appeal window is counted from receiving notice of the denial. Medicare Advantage and Part D Level 1 instructions on Medicare.gov count from the date on the initial denial notice. Use the rule named on your notice, and keep the envelope or portal timestamp as proof of receipt when the rule is receipt-based.

Can I appeal after the deadline?

Sometimes. Medicare describes a good-cause process for late filings. Commercial plans may accept a late appeal in limited circumstances, but that is not a right you should count on. File on time. If you are late, explain the delay in writing and attach evidence; do not wait hoping the plan will extend the clock on its own.

Is a prior-authorization denial on the same clock as a claim denial?

Often yes for commercial internal appeals — Healthcare.gov's 180-day filing window is framed around receiving notice that the claim was denied, and a refused authorization is a coverage decision you can appeal. The plan's time to decide the appeal is shorter for care you have not received yet (Healthcare.gov: 30 days) than for care already received (60 days). Medicare Part D coverage determinations and Medicaid managed-care appeals use their own notices.

How Long Do I Have to Appeal a Health Insurance Denial?

Q: How long do I have to appeal a health insurance denial?

Read the deadline printed on your denial notice. Healthcare.gov states that for many individual and group health plans subject to the Affordable Care Act appeal rules, you must file an internal appeal within 180 days of receiving notice that the claim was denied. The U.S. Department of Labor says ERISA group health plans must give you at least 180 days to appeal. Medicare, Medicaid, and some fully insured state-regulated plans use different clocks. Do not treat 180 days as universal.

By AppealFlow editorial•12 min read•Published August 2026

The appeal deadline is the date printed on your denial notice — not a single national number. Healthcare.gov states that many ACA-covered plans require an internal appeal within 180 days of receiving the denial. The U.S. Department of Labor says ERISA group health plans must give you at least 180 days. Medicare, Medicaid, and some state-regulated plans use different clocks. File using the notice in your hand.

Which Clock Applies Depends on the Plan That Denied You

Key Takeaway: Identify the program first: Marketplace or other ACA individual coverage, ERISA employer group, Medicare, or Medicaid. Each has its own notice and filing rule. A 180-day commercial sentence does not move a Medicare or Medicaid deadline.

Healthcare.gov's appeal overview states that if your insurer refuses to pay a claim or ends your coverage, you can appeal and have the decision reviewed by a third party. The same site's internal-appeals page says you must file the internal appeal within 180 days (6 months) of receiving notice that the claim was denied.

For job-based coverage, the Department of Labor's claims-and-appeals publication says you have at least 180 days to file an appeal and tells you to check the Summary Plan Description if the plan allows longer. That 180-day figure is a federal floor for ERISA health claims, not a promise every letter will print it correctly.

How Long Do Commercial and Marketplace Plans Have to Decide?

Key Takeaway: Filing time and decision time are different. You file by the notice deadline. The plan then has a shorter clock to decide, and that clock is shorter when the care has not happened yet.

Situation	Typical federal pattern	Source to verify
Your time to file an internal appeal	180 days from receiving the denial (ACA page); at least 180 days (ERISA)	Healthcare.gov internal appeals; DOL claims publication
Plan decides a pre-service appeal	Healthcare.gov: 30 days if you have not received the service yet	Healthcare.gov internal appeals
Plan decides a post-service appeal	Healthcare.gov: 60 days if you already received the service	Healthcare.gov internal appeals
ERISA urgent-care appeal decision	As soon as possible, no later than 72 hours after the plan receives the request	DOL claims publication
Your time to request external review	Four months after the insurer's notice or final determination	Healthcare.gov external review

If the plan uses two internal levels, DOL says each level generally gets half the usual decision time, and you get a reasonable period — not a fresh 180 days — to file the second level. For how to request review after the plan's last internal no, see how to request an external review.

What If I Have Medicare or Medicaid Instead?

Key Takeaway: Medicare and Medicaid print their own deadlines. Do not write “I have 180 days under ERISA” on those notices.

Original Medicare, Medicare Advantage, and Part D use the clocks on the Medicare Summary Notice or plan denial. The walkthrough is in how to appeal a Medicare denial. A hospital status change from inpatient to observation uses a separate fast-appeal notice — see what hospital observation status is. Medicaid eligibility and coverage denials use state fair hearings and, for managed care, a plan appeal first — see how to appeal a Medicaid denial.

Need a Draft Before the Deadline?

AppealFlow drafts a letter that names the denial date and the facts you enter. You still file on the portal or address printed on the notice before that clock runs out.

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How Do I Calculate the Date So I Do Not Miss It?

Key Takeaway: Write down the notice date, the receipt date if the rule is receipt-based, and the filing method the letter names. Portal upload, fax, and mail have different “filed” moments. Keep the envelope or the portal confirmation.

Circle the appeal-by date on the denial and put it on a calendar three days earlier
If the letter is shorter than the federal floor for your plan type, file anyway and quote the federal source
Urgent care uses a faster decision clock — see how to request an expedited appeal

Do not wait for a peer-to-peer slot. A clinician call does not pause the written-appeal deadline. File the appeal, then take the call if offered.

Weak vs. Strong Language About the Deadline

Key Takeaway: Name the notice date, the program, and the rule you are using. “I still have time” is not a filing date.

❌ Weak Request	✓ Strong Request
“I have 180 days like everyone else.”	“Denial dated [date], received [date]. This is an ACA/Marketplace claim. I file this internal appeal within 180 days of receipt as stated on Healthcare.gov's internal-appeals page. Claim #[number].”
“My old job plan had 180 days, so Medicare does too.”	“This is a Medicare [Advantage / Part D / Original] notice dated [date]. I am filing by the deadline printed on that notice, not under 29 CFR 2560.503-1.”

Frequently Asked Questions

Filing windows for ACA internal appeals, ERISA group plans, external review, Medicare, and Medicaid.

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AppealFlow.net drafts a letter from the denial date and facts you enter. You still submit it through the process on your notice before that deadline.

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Disclaimer: This article is for educational purposes only and does not constitute medical, legal, or financial advice. AppealFlow.net is not a healthcare provider, insurance broker, or law firm. Appeal clocks differ by plan and program — verify the date on your notice, Healthcare.gov, DOL, Medicare.gov, or your state Medicaid agency before you file. For medical emergencies, call 911. See our full disclaimer.