How do I appeal a Marketplace decision?

You can request an appeal of any Marketplace decision, including:

• Your eligibility to buy coverage in the Marketplace
• Your eligibility for, or the amount of, premium tax credits or cost sharing reductions (for example, a reduction in your premium tax credit amount)
• Untimely (late) notice from the Marketplace about a decision

To start your appeal, review the Marketplace’s decision (called an eligibility notice), which describes the process you should follow. If you have questions about what the notice says or if you want help appealing, contact a Navigator or other assister program.

You generally have 90 days from the date on your eligibility decision notice to request an appeal. If you need health services right away and a delay could jeopardize your health, you can request an expedited appeal. The Marketplace may offer you the option of receiving temporary benefits while your appeal is pending, which you can choose to accept or decline. If you accept temporary benefits during the appeals process and then lose your appeal, you might have to pay back the benefits you weren’t eligible for.

After you submit your completed appeal, the Marketplace will review it and let you know its decision. If you still disagree with the decision, you can request a hearing. While you are waiting for the hearing to take place, the Marketplace may contact you to try to resolve the dispute informally.