Did you know that if you don’t agree with a decision made by the Health Insurance Marketplace concerning you and the Affordable Care Act (ACA), you may be able to file an ACA appeal? Here are types of decisions that can be appealed:
- Eligibility to buy a Marketplace plan, including a Catastrophic plan
- Ability to enroll in a Marketplace plan outside of the Open Enrollment Period (OEP)
- Eligibility for lower costs based on your income
- The amount of savings you’re eligible for or a reduction in the amount of savings
- Eligibility for Medicaid or CHIP (Children’s Health Insurance Program)
- Eligibility for an exemption
- Whether the Marketplace made a timely decision about your eligibility after you applied
The Eligibility Determination Notice you receive after applying to purchase a plan on the Marketplace will give you instructions on how to file an appeal of your decision. Ways to file an ACA appeal include:
- Writing a letter to the Health Insurance Marketplace
- Mailing in an appeal request form
- Faxing your appeal request to the Marketplace
ACA Appeal Request Forms are state specific and can be found at https://www.healthcare.gov/marketplace-appeals/appeal-forms/.
After you file an appeal, you’ll receive a letter acknowledging your appeal request was received. It also provides a description of the appeals process and includes instructions for submitting additional documents, if necessary. The Marketplace is responsible for making a decision and providing you a response within 90 days of when they received your appeal request.
If you’re unsure about how to file an ACA appeal on your own, go to the Marketplace and see how to request a representative or appoint a representative to handle your appeal.