If you apply for a plan on the Marketplace and are told that you don’t qualify or you feel there may be an error, you can request an appeal. You may also be able to request an appeal regarding the following issues:
- Your eligibility to be exempt from purchasing health insurance
- You eligibility for cost-sharing reductions on Marketplace plans including premium credits for a policy
- Late notices received in the Marketplace in regards to a policy-related decision
To begin an appeal, you need to read the official Marketplace decision that could either be a mailed notice or posted online (if you applied online). The decision will explain the reason(s) for a determination and outline steps for an appeal.
You can make an appeal online, in writing, or by contacting the Marketplace call center. You should be prepared to provide your contact information, an explanation your appeal, and supportive documentation, if required. You can also request assistance with your appeal by contacting a Marketplace Navigator at (800) 318-2596.
Once you submit an appeal, the Marketplace will review your concerns and let you know their decision regarding your appeal. If you still disagree with the results of the determination, you will be allowed to request a hearing.
Please note that you may be allowed to receive temporary benefits while your appeal is pending. However, if you accept benefits and lose your appeal you may be required to reimburse the payment.
Tips for Appeal
- Contact the Marketplace to begin the appeal
- Pay attention to timelines/deadlines
- Gather and provide supporting documents
- Follow up to find out the appeal status
- Request a hearing, if needed