Questions & answers · Health insurance
My HealthCare.gov plan denied a claim 5 months ago. Is it too late to appeal?
Health insuranceDeadlinesChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: HealthCare.gov · Internal appeals View original ↗
In short
- Marketplace plans give you 180 days (about 6 months) to appeal.
- The clock starts when you got the denial notice.
- At 5 months, you may have only a few weeks left. File now.
What this means
HealthCare.gov says you must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied [1]. So the count starts on the day you got the denial notice, not the day you got care. If that was about 5 months ago, you may have only a few weeks left. Find the exact date on the letter.
Once you file, the plan must finish the appeal within 30 days for a service you have not received yet, or within 60 days for a service you already received [1]. If the plan still says no, you can ask for an external review by an outside reviewer. You must file it in writing within 4 months after you receive the final denial [2]. A standard external review is decided no later than 45 days after the request is received [2].
Your next step
Find the date you received the denial notice and count 180 days. Send your appeal today in a way you can prove (online with a screenshot, or tracked mail).
Deadline: 180 days after you receive the denial notice.
Check it yourself
Your denial letter states the deadline. The sources do not say what happens if you miss the 180 days on a marketplace plan — "Don't know yet"; ask the plan in writing whether it will accept a late appeal and why.
Where this comes from (2)
[1] HealthCare.gov · Internal appeals · checked 2026-11-05
You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied. … Your internal appeal must be completed within 30 days if your appeal is for a service you haven't received yet. Your internal appeals must be completed within 60 days if your appeal is for a service you've already received.
[2] HealthCare.gov · External Review · checked 2026-11-05
You must file a written request for an external review within 4 months after the date you receive a notice or final determination from your insurer that your claim has been denied. … Standard external reviews are decided as soon as possible — no later than 45 days after the request was received.
How we found this
We matched your question to 2 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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