Your deadlines, explained
Checked against the current rules on September 18, 2026.
There are two clocks running on a Medicare Advantage denial: your deadline to file, and the plan's own deadline to answer once you have. Missing either one changes what happens next — but neither one is as unforgiving as it might feel in the moment.
Here's exactly how each one is calculated, what happens if they're missed, and the two situations where the clock moves in hours, not weeks.
Your deadline to file
65 days from the date on the notice. The rule (42 CFR § 422.582) gives you 60 days from when you receive the denial, and receipt is presumed to be 5 days after the notice's own date unless shown otherwise — 60 + 5 = 65 days from the notice date.42 CFR 422.582
Later levels have their own 60-day deadlines, measured from the decision notice at that level rather than the original denial — see the five appeal levels for each one.
The 5-day mailing presumption isn't a formality — it exists specifically because the regulation assumes you didn't get the notice the same day it was printed. If you can show you actually received it later than that, the clock can start from the real receipt date instead.
The plan's deadline to answer
The plan must decide within 30 calendar days for a request about a service you haven't received yet, 60 calendar days for a request about payment for something already provided, or 72 hours if the request is expedited (42 CFR § 422.590).
If the plan misses its own deadline, that silence is legally treated as a denial, and the plan must forward the case to the Independent Review Entity automatically — you don't have to do anything to trigger it.42 CFR 422.590
The specific number of days depends on what kind of request it is: a service you haven't received yet moves faster through the system than a bill for something already provided, because the stakes of waiting are different.
Expedited (fast) review
You or your doctor can ask the plan to expedite (speed up) its decision if waiting the standard timeframe could seriously jeopardize your health or your ability to regain function (42 CFR § 422.584).42 CFR 422.584
Expedited review isn't automatic just because a family feels urgency — it turns on a specific standard about health risk. Either you or the treating doctor can request it, and a doctor's own request for expedited handling is generally treated as establishing that the standard is met.
The two same-day fast-appeal windows
Two specific notices come with their own same-day fast-appeal option through an outside reviewer (the QIO), separate from the standard appeal timeline:
NOMNC — ending nursing home, rehab, or home health services: Request the fast appeal by the date and time on the form — no later than noon of the day before your services end.42 CFR 422.626
Important Message from Medicare — hospital discharge: Request review no later than the day of discharge, before you leave the hospital.42 CFR 422.622
The plan won't approve care you need now: Ask the plan to expedite. It must decide an organization determination within 72 hours (24 hours for a Part B drug), or an expedited reconsideration within 72 hours — and it must honor a doctor's request to expedite.
Questions people ask
- What date does my 65-day deadline actually start from?
- The date printed on the denial notice — not the date you opened the envelope or noticed it. The extra 5 days beyond the regulation's 60-day window already account for mail transit.
- Can I ask for more time?
- The first-level deadline can be extended for good cause. There's no guaranteed list of what qualifies — a serious illness, a family emergency, or not having received the notice are all reasonable explanations.
Sources — last checked September 18, 2026
- 42 CFR 422.582as of September 18, 2026
- 42 CFR 422.584as of September 18, 2026
- 42 CFR 422.590as of September 18, 2026
- 42 CFR 422.622as of September 18, 2026
- 42 CFR 422.626as of September 18, 2026
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By CaseWhy Appeals editorial. See how this content is produced. Not legal advice. Not affiliated with or endorsed by Medicare, CMS, or any health plan. A product of CaseWhy LLC.
