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How to appeal a Marketplace decision

What can I appeal?

If you don’t agree with a decision made by the Marketplace, you generally have 90 days from the date of your Eligibility Notice to ask for an appeal.
Notice:
If the Marketplace told you to submit documents to confirm information on your application, do that first. You'll get an updated decision about your eligibility, so you might not need to file an appeal. Get details on submitting documents.
You can appeal if the Marketplace said you aren’t eligible to:
  • Buy a Marketplace plan or 
    .
  • Get financial help with Marketplace costs (including the amount you think you qualify for).
  • Enroll in or change your Marketplace plan with a
    .
  • Get an
    .
You can also appeal:
  • If the Marketplace didn’t let you know your eligibility results soon enough.
  • The date your Marketplace coverage started.
  • Other decisions if you live in certain states.
    • If you live in Alabama, Alaska, Louisiana, Missouri, Montana, North Carolina, Virginia, West Virginia, or Wyoming, you can also appeal if you're told you're not eligible for Medicaid or the Children's Health Insurance Program (CHIP).
    • If your state has its own Marketplace website, you can appeal their decision. Check for your state.

What can't I appeal?

You disagree with:
  • The date the Marketplace ended your coverage.
  • Information on your tax Form 1095-A, or you want a corrected form.
Your health insurance company:
You also can't appeal if you:
  • Want to change information on your Marketplace application.
  • Filed your federal income tax return and have to pay back some or all of the premium tax credits you used during the year to lower your monthly premiums.
  • Applied for coverage through an employer in the SHOP Marketplace. But, you can file a SHOP employee complaint.

 
Check how to appeal

Can I appeal more than 90 days from the date of my Eligibility Notice?

If it's been more than 90 days since you got your Eligibility Notice, explain why you missed the deadline when you file your appeal. You may be able to get an extension.
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