Marketplace Verification and Appeals

I signed up for Marketplace coverage this year. I am sure I never missed a payment, but the insurer says I didn’t pay the October premium and won’t let me renew coverage for next year unless I repay it. Can I appeal this decision?

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This is unclear.  So far, the federal government has not established a clear appeals process for problems that arise under the rule that permits insurers to refuse to renew Marketplace coverage for nonpayment.  It is important that you sign up for coverage before the end of Open Enrollment.  At this point, options to consider include:

  • Ask your insurer to reconsider. Be sure to present your cancelled check or other proof that you paid.
  • Report this problem to the Marketplace and to your state insurance regulator and ask their help resolving the problem
  • Review Marketplace plan options offered by any other insurers and consider signing up for one of those if you can’t get this problem resolved before the end of Open Enrollment.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.