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Your appeal rights, by plan type
Every denial can be appealed. The rules — and the deadlines — depend on what kind of plan you have. Pick yours.
Medicare AdvantageYou have a Medicare plan run by a private insurer (an “MA” or “Part C” plan) — the card says Medicare Advantage, and the insurer is a company like UnitedHealthcare, Humana, or Aetna.Employer Plans (ERISA)Your insurance comes through a private-sector job — yours or a family member's. Most working-age Americans with employer coverage are in an ERISA plan, even when a big-name insurer administers it.ACA / Marketplace PlansYou bought your plan on healthcare.gov or a state exchange, or you have an individual (non-employer) plan regulated by the Affordable Care Act.MedicaidYour coverage is Medicaid or CHIP — often through a managed care company (Centene, Molina, UnitedHealthcare Community Plan, and others run state Medicaid plans).
State external review
After your insurer’s internal appeal, most states give you a binding outside review by independent physicians. Deadlines and processes vary by state.