How do I appeal a SHOP Marketplace decision?



Both employers and employees of small businesses can appeal decisions by the SHOP Marketplace.

Employers and employees can file SHOP appeals

An employer or an employee may file an appeal a SHOP decision. You may have an authorized representative file an appeal for you. You may also get help in a language other than English

SHOP Marketplace decisions you can appeal

Both the employer and the employee have the right to appeal in 2 circumstances:

  • The employer has received a notice that denies them eligibility to participate in the SHOP Marketplace
  • The SHOP hasn’t made a decision about the employer’s eligibility in a timely manner

2 ways to file a SHOP appeal

Your SHOP eligibility determination letter will explain how to file an appeal in a way that’s specific to your individual situation. In general, you can appeal your eligibility results in 2 ways:

  • Call 1-800-706-7893 (TTY: 1-800-706-7915) Hours: Monday through Friday, 9 a.m. to 7 p.m. EST. Agents and brokers may also use this number.

  • Write a letter to:

    Health Insurance Marketplace
    465 Industrial Blvd.
    London, KY 40750-0001

After you file an appeal

You’ll get a letter or phone call saying that your appeal was received. It will provide a description of the appeals process and instructions for submitting additional materials if needed.