The Marketplace Appeals Center will send you a notice in the mail confirming receipt of your appeal and giving more information about the appeal process within 7-10 business days.
If your appeal request is accepted, the Marketplace Appeals Center will review your appeal. If the letter says your appeal request is invalid, you might need to take certain actions to get your request considered or find other ways to get help. Learn what to do if your Marketplace appeal is invalid (PDF, 136 KB).
How your appeal is processed
In general, the Marketplace Appeals Center processes appeals in the order they come in. How long it takes for a decision usually depends on the issue you’re appealing and whether the Marketplace needs more documentation to confirm your eligibility.
- The Marketplace Appeals Center reviews your appeal, including the information the Marketplace uses to determine your eligibility.
- You may get a letter asking for more information or documentation, like a copy of a passport. Sending the requested information as soon as possible will help the Marketplace Appeals Center resolve your case informally and quickly.
- If the Marketplace Appeals Center can resolve your appeal informally, they'll send you a "Notice of Informal Resolution." You can expect an informal resolution notice within 30 days after you submit any needed information.
- The notice tells you how to request a hearing if you aren't satisfied. Most hearings are conducted over the phone.
- It's a good idea to save copies of all forms and notices related to your appeal. If needed, you can also request a copy of your appeal record (PDF, 1.22 MB).
When your appeal is resolved
You'll get a notice with the Marketplace Appeals Center's final decision about your eligibility. Your Marketplace eligibility may change, depending on the decision. For example:
- If you appealed your eligibility for coverage, the letter will tell you if you qualify to buy a Marketplace plan.
- If you appealed your eligibility for financial help, such as premium tax credits or cost-reductions, the letter will say if you qualify to use a different amount of premium tax credit each month, for savings on out-of-pocket costs, or for coverage through your state's Medicaid or CHIP programs.
- The letter will explain how the Marketplace Appeals Center reached its decision, and your next steps.