You can request an appeal of any Marketplace decision, including decisions about
To make your appeal, start by reviewing the Marketplace’s decision. You will have received the decision (called a determination notice) online if you initially applied online, or in the mail if you submitted a paper application. The notice will explain the reasons for the decision and the process you should follow if you want to appeal. To request an appeal, you’ll have to provide your name and contact information and an explanation of what you are appealing and why. You can make your appeal online or in writing or over the phone by calling the Marketplace call center.
You can submit documents to the Marketplace that support your case. You can submit documents along with your initial appeal request or at any time during the appeal process, up until a hearing.
The Marketplace may offer you the option of receiving temporary benefits while your appeal is pending. You can accept the temporary benefits or waive them. 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.
The Marketplace will review your completed appeal once it is submitted. Then the Marketplace will 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.
You may want to ask a Navigator for help requesting an appeal.
Posted in: Marketplace Verification and Appeals