Medicare Advantage Coverage Decision Clock
Medicare Advantage coverage-decision deadline.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Kind of request
- Standard, item or service needing prior authorization
- Plan received the request
- 2026-10-05T14:00
- Plan took the 14-day extension
- No
Result: 42 CFR 422.568(b)(1)(ii): decision due October 12, 2026 (7 calendar days after receipt).
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Kind of request
- Plan received the request (YYYY-MM-DDTHH:MM)
- Plan took the 14-day extension
How this is calculated
Citation
42 CFR 422.568 (standard: 14 calendar days, or 7 for prior authorization from January 1, 2026; Part B drug 72 hours; up to 14-day extension), 422.570, 422.572 (expedited: 72 hours; Part B drug 24 hours). Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.