How deadlines are counted, and what to do if you missed one

Every deadline has two parts: a number of days or months, and a starting point. Most of the confusion comes from the starting point. Write down both the date on your notice and the date it reached you, count from the earlier one, and file early. If a deadline has already passed, do not give up. Some programs accept late requests, and some plan mistakes open other doors.

What this means

What the clock counts from

Check the date on your notice, which controls. Across the rules we checked, deadlines start from one of three places.

• The date you receive the notice. Private plan internal appeals (at least 180 days) and external review (at least four months).
• The date printed on the notice. Medicare Advantage and Medicare drug plan appeals: the rule says 60 days after receipt and treats receipt as 5 days after the notice date, so the safe count is 65 days from the date on the notice. Medicaid managed care plan appeals: 60 calendar days from the date on the notice. Marketplace eligibility appeals: 90 days from the date of the eligibility notice. Federal employee plans: 6 months from the date of the denial notice.
• The mailing or postmark date. A TRICARE reconsideration must be mailed (postmarked) within 90 days of the date on the decision. A Medicaid fair hearing in a fee-for-service program must be requested within a reasonable time that the state sets, not more than 90 days from the date the notice was mailed.

Original Medicare mixes two: the first appeal is due within 120 calendar days of receiving the decision, receipt is presumed to be 5 calendar days after the notice date, and the request counts as filed on the day the contractor receives it.

What “at least” means

Many federal deadlines are minimums. A private plan must give you at least 180 days to appeal and at least four months for external review. It may give more, never less. States may give more too: California allows 6 months after the plan’s written response, and Maine 12 months after you receive the insurer’s final decision.

When two sources disagree, use the shorter. Delaware’s official sources differ on whether the four months start from the letter date or the date you receive it, so count from the date printed on the letter. Kentucky’s statute says 60 days while an older state guide says four months, so assume the shorter until the department confirms.

Weekends, holidays and business days

For the federal external review process, a deadline that falls on a weekend or federal holiday moves to the next business day. The rules we checked do not say the same for other deadlines, so do not count on it. File at least a few days early, by a method that proves the date. Note which deadlines use business days (some steps in external review) and which use calendar days (Medicare’s).

When the plan’s own clock starts

The plan’s decision clock starts when you file under its reasonable procedures, even if you left out information. A plan may extend a decision on a claim for care before or after it happens once, by up to 15 days, for reasons beyond its control, if it tells you before the first period ends. Urgent claims have no extension. In Original Medicare, each time you send more evidence after filing, the contractor’s deadline can be extended by up to 14 days.

What to do if you think you missed a deadline

1. Check the date again. Which date are you counting from? Receipt, notice date or postmark? You may have more time than you think.
2. Ask the plan, in writing, to accept your request, and explain briefly why it was late. Say what happened. Keep a copy and the date you sent it. We did not find a federal good-cause rule for private plan deadlines, so ask the plan and check your plan document and state law.
3. Look for a good cause rule. Original Medicare accepts a late appeal for good cause, and the same standard is used at later levels. Examples include serious illness, a death or serious illness in the immediate family, records destroyed by fire or accident, wrong or incomplete information from the contractor, and not receiving the notice. Federal employee plans can extend the deadline for circumstances beyond your control. Marketplace eligibility appeals may be accepted late if you explain the delay. California’s independent medical review may accept a late request if circumstances prevented you from filing on time.
4. Check whether the plan broke its own rules. A plan that does not follow a compliant claims process can lose its protection: for a plan covered by the Employee Retirement Income Security Act (ERISA), you are treated as having finished the plan’s steps and may go to court; for a non-grandfathered plan that does not “strictly adhere”, you may go straight to external review or court, with limits for minor errors. A Medicare Advantage plan that misses its deadline must send your case for independent review. See when the plan is silent.
5. Try a new request if the program allows it. In Veterans Affairs health care, a Supplemental Claim with new and relevant evidence can be filed at any time, but file it within one year of the decision to keep the claim continuously pursued. Ask other programs whether a new request with new evidence is allowed.
6. Complain, and ask for help. A regulator complaint does not extend a deadline, but it can raise the problem. Free counselors can sometimes tell you what is possible. Use the find help tool.
7. Do not wait on court deadlines. ERISA sets no deadline for benefit lawsuits, but a plan document may set its own, even one that starts before your appeals end, if it is reasonable. Check your plan document early.

What the plan may say, and what to say back

“Your appeal is late.” Say: “Please tell me in writing which date you counted from and which provision sets the deadline. I am asking you to accept my appeal because [reason].”

“We never received your appeal.” Say: “I sent it on [date] by [method]. Here is my proof.” Next time, send by a method that records delivery, and keep the receipt.

The rule

A late request for a first appeal in Original Medicare can be accepted for “good cause”. The regulation’s examples include serious illness, a death or serious illness in the immediate family, records destroyed by fire or other accident, wrong or incomplete information from the contractor, and not receiving the notice. Source: Code of Federal Regulations (CFR) Title 42, section 405.942(b).

Watch for

• Fast appeals have hour-level clocks. For a Medicare hospital discharge you ask no later than the day you leave. If you miss the day-of-discharge deadline, you can still ask while you are in the hospital, or within 30 days after you leave, but without the fast deadline or protection from charges.
• Old extensions are over. The pandemic-era extensions of claims and appeal deadlines ended with the “Outbreak Period”, which the federal agencies said would end on 10 July 2023.
• Agencies sometimes extend, but not to count on. When the federal external review system was closed in July 2026, people with deadlines from 1 July to 3 August 2026 were given until 2 October 2026. That has passed.
• Pages that disagree. If a plan page and your notice differ, use the stricter reading.

What next

• See the numbers for each program: appeal deadlines by coverage type.
• If the plan has gone quiet: when the plan is silent.
• Track every date in one place with the appeal tracker and the decision clock.
• Go to the topic page, know your deadlines.