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How to appeal a Marketplace decision

How do I file an appeal?

How you file an appeal (and the form you use) depends on where you live and if you have a Marketplace account.

Tips for filing an appeal

  • Include copies of any documents you have to support your appeal. Don't send original documents. Get details based on your situation.
  • Generally, appeals are processed in the order we get them. You can ask for a faster (expedited) appeal if you think waiting for a standard decision may seriously put your health at risk, like if you're in the hospital or need urgent medication.
  • If you need help, you can have someone you trust (like a family member, friend, advocate, or attorney) act on your behalf for your appeal by giving them permission to be your authorized representative. Get help with your appeal.
  • The decision of an appeal could impact coverage for other members of your household.
  • If eligible, enroll in a plan and pay your premiums during your appeal. If you drop or lose your coverage during your appeal, you might have to wait to re-enroll (even if your appeal is successful).
Notice:
We'll mail you a letter telling you if you're eligible to keep your coverage and continue to get financial help during your appeal. If you get the premium tax credit during your appeal and your appeal is unsuccessful, you may have to pay back the tax credits you got during your appeal when you file your taxes.

Answer a few questions to find out