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How to Find Your Health Insurance Appeal Deadline (ERISA vs. ACA vs. Medicare)

By the AppealAngle Research Team · Published July 11, 2026

Before you write a single word of your appeal, find your deadline. It is the one part of the process where being right most of the way through does not help you: if you file even a day late, your insurer or plan can refuse to consider the appeal at all, and a late filing can forfeit your right to the independent external review that comes after it. A strong medical argument is worthless if it arrives after the window has closed.

The tricky part is that there is no single deadline for "health insurance." The number of days you get, and who enforces it, depends on what kind of plan you have. This guide shows you how to identify your plan type, what the common windows are, and exactly where your real, binding deadline is written down.

Step 1: Figure out what kind of plan you have

Your plan type decides which rulebook governs your appeal. The main categories are:

• Self-funded employer plan (ERISA). Your employer pays claims directly and hires an insurer only to administer the plan. These are governed by federal ERISA claims-procedure rules from the U.S. Department of Labor.
• Fully-insured employer plan. Your employer buys coverage from an insurance company that bears the risk. These follow ACA rules plus your state's insurance laws.
• ACA Marketplace or individual plan. Coverage you bought yourself, on or off HealthCare.gov. Governed by ACA federal rules and state law.
• Medicare Advantage (Part C) or a Medicare drug plan. A private plan that administers your Medicare benefits under CMS rules.
• Original Medicare. Traditional fee-for-service Medicare, run through federal contractors.
• Medicaid (or CHIP). Administered by your state within federal minimums, with a "state fair hearing" as the appeal route.

How to tell which one you have

You usually do not need to guess. Try these, in order:

• Read the denial letter. An Explanation of Benefits (EOB) or adverse benefit determination from a commercial plan will name your appeal rights and deadline directly. A Medicare Summary Notice (MSN) means Original Medicare. A notice from your state Medicaid agency means Medicaid.
• Check your plan documents. Look at your Summary Plan Description (SPD), Summary of Benefits and Coverage (SBC), or Evidence of Coverage (EOC). ERISA plans are required to give you an SPD; it will describe the claims and appeals procedure.
• Ask HR one direct question. If your coverage is through work, ask your benefits or HR contact: "Is our health plan self-funded or fully-insured?" That single answer tells you whether federal ERISA rules or state insurance law drives your appeal. If HR says the company "pays its own claims" and uses the insurer only to process them, it is self-funded (ERISA).

This matters because the same insurer's logo can sit on top of very different rulebooks. A card that says "Blue Cross" might be an ERISA self-funded plan, a fully-insured employer plan, or an individual ACA plan — each with a different appeals path.

Step 2: Know the typical windows

Once you know your plan type, you can find the deadline that applies. These are the common federal figures for 2026 — but treat them as a map, not as your personal deadline (see the warning below).

Internal appeal — ACA and ERISA plans. For group health plans and ACA Marketplace/individual coverage, you generally get 180 days (about six months) from the date you receive the denial notice to file your internal appeal. HealthCare.gov states plainly: "You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied" (HealthCare.gov, internal appeals). Federal ERISA claims-procedure rules require group plans to give you at least 180 days to appeal an adverse determination (U.S. Department of Labor / EBSA).

External review. If your internal appeal is denied, you can take the dispute to an independent third party. For plans following the federal process, you must file the written request for external review within four months after the date you receive the final internal denial (HealthCare.gov, external review). The external reviewer's decision is binding — the insurer must accept it. (Note: as of July 1, 2026, the HHS-administered Federal External Review Process was temporarily unavailable for certain plans in a handful of states; if that affects you, follow the instructions in your plan's notice — HealthCare.gov.)

Expedited / urgent timelines. If waiting for the standard process could seriously jeopardize your health or ability to regain function, you can request an expedited appeal, and in urgent situations you may file your internal appeal and external review request at the same time (HealthCare.gov). The filing window to start is still tied to your denial, but the decision comes back far faster — expedited external reviews are generally decided no later than 72 hours (HealthCare.gov).

Medicare is different. Medicare has its own multi-level structure — generally five levels of appeal, each with its own deadline (Medicare.gov). In Original Medicare, you start a Level 1 "redetermination" by the deadline printed on your Medicare Summary Notice, and you generally have 180 days after a Level 1 decision to request a Level 2 reconsideration (Medicare.gov, Original Medicare appeals). In a Medicare Advantage or drug plan, you request a plan-level reconsideration first, commonly within 60 days of the denial. Do not apply the 180-day ACA figure to Medicare — check your notice and Medicare.gov instead.

Step 3: Compare your plan type at a glance

Step 4: Find your exact, binding deadline

The figures above are the common federal defaults. Your actual deadline is a specific date, and it is written down in two places:

• Your denial letter. Insurers are required to tell you how to dispute a decision, and the notice must spell out your appeal rights and time limits (HealthCare.gov). Look for language such as "you have X days from the date of this notice to appeal," and note the date printed at the top of the letter — the clock usually starts from when you receive the notice.
• Your plan documents. The SPD, Evidence of Coverage, or SBC restates the appeals procedure and deadlines in full. If the letter and the plan document ever disagree, the longer, more protective window is usually the safe one to plan around — but confirm with your plan.

Two dates matter, not one: the deadline to file your internal appeal, and — after you get the final internal denial — the separate deadline to request external review. Calendar both the day you read the letter.

The bottom line

The deadline is the first thing to solve because it is the one mistake you cannot fix later. Identify your plan type — self-funded ERISA, fully-insured, ACA individual, Medicare Advantage, Original Medicare, or Medicaid — because it decides which rulebook and which clock apply. Learn the common windows (often 180 days to file an internal appeal and four months to request external review for ACA and ERISA plans; separate multi-level timelines for Medicare). Then ignore the averages and pull the exact date from your own denial letter and plan documents. Put both the internal and external deadlines on your calendar today, and give yourself a cushion. Everything else in your appeal can be strengthened later; the deadline cannot.