After you file an appeal, you’ll get a letter saying your request was received, and whether it has been "accepted" or is "invalid."
If your appeal request is accepted
If the letter says your request is accepted, the Marketplace Appeals Center will review your appeal. The letter:
- Provides a description of the appeals process
- Includes instructions for submitting additional material, if necessary
If your appeal request is "invalid"
If the letter says your appeal request is "invalid," the Marketplace Appeals Center isn't able to act on your appeal.
How your appeal is processed
In general, the Marketplace Appeals Center must tell you the decision and mail the response within 90 days of when it received your appeal request.
- The 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. If you send this information quickly, they may be able to informally resolve your case fairly quickly.
- If the Marketplace Appeals Center resolves your appeal informally, they'll send you a "Notice of Informal Resolution."
- 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).
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 assistance, 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 Appeals Center reached its decision, and your next steps.