Questions & answers · Health insurance
How fast must a Medicare Advantage plan decide a prior authorization request?
Health insuranceAppealChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: 42 CFR 422.568 (eCFR (current as of 2026-11-02)) · § 422.568(b)(1) View original ↗
In short
- From 2026, a standard prior approval request gets an answer in 7 days.
- Fast requests get 72 hours, or 24 hours for a Part B drug.
- The plan may add up to 14 days in some cases.
What this means
For a standard request, if the service or item is subject to the plan's prior authorization rules, the plan must decide within 7 calendar days after it gets the request. This applies on or after January 1, 2026 [1]. Other standard requests get 14 calendar days [1]. In some cases the plan may take up to 14 more calendar days, for example if you ask for more time [2]. If the plan agrees to a fast (expedited) decision, it must decide no later than 72 hours after it gets the request. For a Part B drug, the limit is 24 hours [3]. For services or items, the plan may extend the 72-hour deadline by up to 14 calendar days in some cases. The 24-hour Part B drug deadline cannot be extended [3].
Where this comes from (3)
[1] 42 CFR 422.568 (eCFR (current as of 2026-11-02)) · § 422.568(b)(1) · checked 2026-11-05
(i) For a service or item not subject to the prior authorization rules in § 422.122, 14 calendar days after receiving the request for the standard organization determination. (ii) Beginning on or after January 1, 2026, for a service or item subject to the prior authorization rules in § 422.122, 7 calendar days after receiving the request for the standard organization determination.
[2] 42 CFR 422.568 (eCFR (current as of 2026-11-02)) · § 422.568(b)(2) · checked 2026-11-05
The MA organization may extend the timeframe by up to 14 calendar days under any of the following circumstances: (A) The enrollee requests the extension. (B) The extension is justified and in the enrollee's interest due to the need for additional medical evidence from a noncontract provider that may change an MA organization's decision to deny an item or service.
[3] 42 CFR 422.572 (eCFR (current as of 2026-11-02)) · § 422.572(a) · checked 2026-11-05
an MA organization that approves a request for expedited determination must make its determination and notify the enrollee … no later than 72 hours after receiving the request. (2) Requests for a Part B drug. … no later than 24 hours after receiving the request.
How we found this
We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-05.
What we don’t know yet
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Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
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