Questions & answers · Health insurance
How long do I have to appeal a Medicare Part D denial, and how fast must the plan decide?
Health insuranceAppealChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: 42 CFR 423.582 (eCFR (current as of 2026-11-02)) · § 423.582(a)-(b) View original ↗
In short
- Appeal a Part D denial within 65 days of the notice.
- The plan decides in 7 days, or 72 hours if urgent.
- A payment appeal can take 14 days.
What this means
You must file a Level 1 appeal (called a redetermination) within 60 calendar days after you receive the written coverage determination notice. The rule assumes you received it 5 calendar days after the date on the notice [1]. If you show good cause, the plan may give you more time [1]. Medicare.gov says you must ask for an appeal within 65 days [2]. For a standard appeal about getting a drug, the plan must decide no later than 7 calendar days after it gets the request [3]. If your appeal asks the plan to pay you back for a drug, the plan has no later than 14 calendar days [3]. If the plan agrees to a fast (expedited) appeal, it must decide no later than 72 hours after it gets the request [3].
Where this comes from (3)
[1] 42 CFR 423.582 (eCFR (current as of 2026-11-02)) · § 423.582(a)-(b) · checked 2026-11-05
a request for a redetermination must be filed within 60 calendar days after receipt of the written coverage determination notice … (1) The date of receipt of the coverage determination or at-risk determination is presumed to be 5 calendar days after the date of the written coverage determination
[2] Appeals in a Medicare drug plan · Level 1 appeals: Redetermination from your plan · checked 2026-11-05
You, your representative, or your prescriber must ask for an appeal within 65 days
[3] 42 CFR 423.590 (eCFR (current as of 2026-11-02)) · § 423.590(a), (b), (d) · checked 2026-11-05
no later than 7 calendar days from the date it receives the request for a standard redetermination … no later than 14 calendar days from the date it receives the request for redetermination … no later than 72 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
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
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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