Tool
When is your appeal due?
Put in the date on your denial notice and pick the plan that denied you. You get the dates the published rules count to, with the rule and its source beside each one.
Read this first. These are dates the published rules produce, not advice about your case. We are not a law firm, an insurer or a government office. Your own notice governs: if it prints a deadline or a filing address, work to that one. Rules change, so check the sources before you rely on a date here.
Every window this tool counts to
The tool holds no numbers of its own. These are the windows behind it, each one carrying the document it was read from. Enter a date above and it counts from your date to these.
File your internal appeal with the plan
180 days
Counted from the day you received the plan's denial notice. This is the minimum the plan has to allow. Your plan may give you longer; it may not give you less.
You have 180 days from receiving a denial to file an internal appeal with a commercial plan.
HealthCare.gov · source · read August 2026
Request external review by an independent organization
About four months
Counted from the date of the plan's final internal denial. This is the window the regulation sets.
You have four months from the final internal denial to request an external review, and the independent reviewer's decision binds your plan.
HealthCare.gov · source · read August 2026
File a redetermination with your Part D plan
65 calendar days
Counted from the date on the coverage determination notice. This is the window the regulation sets.
CMS specifies a 65-calendar-day filing window measured from the date on the coverage determination notice for a Part D redetermination.
Centers for Medicare & Medicaid Services · source · read October 2026
Ask the independent review entity to reconsider
65 calendar days
Counted from the date on the plan's redetermination notice. This is the window the regulation sets.
CMS specifies a 65-calendar-day filing window measured from the date on the plan's redetermination notice for a Part D reconsideration.
Centers for Medicare & Medicaid Services · source · read October 2026
Request a fair hearing from the state
90 days
Counted from the date the notice of action was mailed. This is the outside limit. Your state is allowed to set a shorter window, and several do.
Federal rules require the agency to allow a reasonable time, not to exceed 90 days from the date the notice of action is mailed, to request a hearing.
42 CFR §431.221(d) · source · read August 2026
What this tool will not do
It will not count to a date it cannot stand behind. Three cases come up often enough to name.
- A clock that has not started. External review runs from your plan's final internal denial, and a Part D reconsideration runs from the redetermination. Neither date exists until that decision arrives, so the tool says so instead of counting from your first notice.
- A state with two clocks. Florida publishes one window for fee-for-service and a longer one after a managed care plan appeal. Which binds you turns on your own coverage, so we quote the rule and leave the choice with you.
- A state whose rule we could not open. Where a state's own hearing page would not load for us, we publish no number for it at all rather than copy one from a summary written by somebody else.
Every window above is the same sourced fact the procedure pages cite. There is one authored copy of each figure on this site and this page is a reader of it, not a second copy, so a date here cannot drift away from the document it came from. The procedures set out what to actually file on each route.
Where this comes from
Read August 2026 unless marked.
- HealthCare.gov — www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/
- HealthCare.gov — www.healthcare.gov/appeal-insurance-company-decision/external-review/
- Centers for Medicare & Medicaid Services — www.cms.gov/medicare/appeals-grievances/prescription-drug/redeterminatio (read October 2026)
- Centers for Medicare & Medicaid Services — www.cms.gov/medicare/appeals-grievances/prescription-drug/reconsideratio (read October 2026)
- 42 CFR §431.221(d) — www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-E
Denied and not sure which route is yours? Start on the denial page. If you are on Medicaid, the coverage matrix shows what each state we have read publishes.
Nothing here is medical or legal advice, and no date on this page is a prediction about your case. Every figure carries the document it came from and the month we read it.