How to appeal a Marketplace decision
When can you appeal?
If you don’t agree with a decision made by the Health Insurance Marketplace®, you may be able to file an appeal.
You generally have 90 days from the date of your Eligibility Notice to ask for an appeal. (The “Next steps” section in that notice will tell you if you can file an appeal.)
Marketplace decisions you can appeal:
If the Marketplace said you aren’t eligible to:
- Buy a Marketplace plan or a
- Get financial help with Marketplace costs or you disagree with the amount of financial help you qualify for.
- Enroll in or change your Marketplace plan with a Special Enrollment Period.
- Get an exemption from the requirement to have health insurance.
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.
|You can appeal:||If you live in:|
|The state said you aren’t eligible for Medicaid or CHIP||Alabama, Alaska, Louisiana, Montana, Virginia, West Virginia, or Wyoming|
You can appeal through the Marketplace Appeals Center, but appealing through your state may be faster.
|A decision made by your state’s Marketplace program||California, Colorado, Connecticut, District of Columbia, Idaho, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, or Washington|
Marketplace decisions you can’t appeal
You disagree with:
- The date the Marketplace ended your coverage.
- Information on your Form 1095-A, or you want a corrected form.
Your health insurance company:
- Didn’t apply your premium tax credit correctly.
- Refuses to pay a claim or ends your coverage. (Instead, you can file an appeal with your plan. Learn how to appeal a health plan decision.)
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.
Appealing after 90 days
If you miss the 90 day timeframe to file an appeal, you may be able to get an extension. When you file your appeal, explain the reason why you missed the deadline in your appeal request.