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If you do not agree with a decision made by the Health Insurance Marketplace, you may be able to file an appeal.
Eligibility to buy a Marketplace qualified health plan (QHP), including a catastrophic plan
Eligibility for lower costs, including the amount of advance payments of premium tax credit or cost-sharing reductions
Eligibility for a special enrollment period to enroll in a Marketplace QHP outside the regular open enrollment period
The Marketplace eligibility decision must be “final” before an appeal is submitted.
The appeal must be received within 90 days of the contested Marketplace eligibility decision.
The request for appeal must be about a matter that is eligible for a Marketplace appeal.
The appeal must be requested by a consumer or by an authorized representative appointed in writing by the consumer.
If the appeal request does not meet these requirements, the consumer will get a notice explaining why the request is invalid and how to fix the problem and resubmit the appeal.
Complete and submit an online appeal request form.
Writing a letter to:
Health Insurance Marketplace
Attn: Appeals
465 Industrial Blvd.
London, KY 40750-0061
Mailing in an appeal request form. Proper Forms can be found at http://www.healthcare.gov/
Faxing your appeal request to a secure fax line: 877-369-0130
Consumers can file a request for an expedited appeal. Requests to expedite the appeal should explain how a standard appeal would jeopardize their life, health, or ability to attain, maintain, or regain maximum function.
The request to expedite your appeal will be processed as quickly as possible. A final decision must be made as quickly as your situation requires.
Informal Resolution:
If possible, the MAC will try to resolve the appeal based on the available information.
This decision will be binding if the consumer is satisfied.
Hearing:
In some cases, the appeal may go straight to a hearing.
If the consumer is dissatisfied with the informal resolution, a hearing may be requested.
For questions related to the appeals process:
Call the Marketplace Call Center at 800-318-2596
For questions related to an appeal that has been submitted:
Call the Marketplace Appeals Center at 855-231-1751 or TTY users 855-739-2231
