How We Use Your Data
Get details below about how we, the Centers for Medicare & Medicaid Services (CMS), use your information in the Health Insurance Marketplace®, your rights to access records that we maintain about you, your right to file an appeal, and other helpful information.
Learn more about:
What's the Marketplace?
The Marketplace is a resource where you can learn about your health coverage options, compare health insurance plans based on costs, benefits, and other important features, choose a plan, and enroll in coverage.
It also provides information on programs that help people with low to moderate income and resources pay for coverage. This includes ways to save on the monthly premiums and out-of-pocket costs of coverage available through the Marketplace, and information about other programs, including Medicaid and the Children’s Health Insurance Program (CHIP).
In some states, the Marketplace is run by the state. In others it is run by the Centers for Medicare & Medicaid Services (CMS), a component of the U.S. Department of Health and Human Services (HHS). Find out if your state has its own Marketplace.
The following information describes how the CMS Marketplaces use your information. This information doesn’t apply to Marketplaces run by states.
How does the Marketplace use my information?
As a federal agency operating the Marketplace and associated programs, we're required to protect the information collected and maintained. We respect your right to privacy and will protect your information in the ongoing operation of the Marketplace in accordance with all required laws, regulations and standards. “You” refers to any person whose information is entered on your application, or those acting on such a person’s behalf.
We need your information to determine eligibility for:
- Enrollment in a Marketplace plan, also known as a Qualified Health Plan
- Insurance affordability programs
When you apply for health coverage or an exemption, your information may be used to:
- Help you with the application process
- Verify information like your identity and any income history you provide
- Give you accurate information about as many different cost-saving programs as possible
- Help you resolve questions about the results of your application, including an appeal if you decide to file one
- Communicate with you during the eligibility process
If you choose to answer optional household demographic questions about race, ethnicity, sex assigned at birth, gender identity, or sexual orientation, your information:
- Won’t impact your coverage eligibility or plan costs, whether you answer the questions or not
- Won’t be used to understand your personal health care needs, or to determine available plans or what health care is covered
- Will help us to improve the Marketplace program and to understand whether people in the U.S. get fair and equal access to coverage
If you choose to answer optional household demographic questions about sex assigned at birth, gender identity, or sexual orientation, your information won’t be shared with your state, your insurance company, or your health care providers.
If you choose to answer optional household demographic questions about race and ethnicity, your information may be shared with your state, your insurance company, or your health care providers.
When you enroll in health coverage, your information may be used to:
- Help you enroll
- Report and manage the advance payments of premium tax credit and cost-sharing reductions to the issuer of your Marketplace plan, if you’re eligible
- Communicate with you throughout the enrollment process
After you enroll in health coverage, your information may be used to:
- Continue communications with you
- Help you keep your coverage up to date
- Verify your continued eligibility
- Perform ongoing execution of the functions of the Marketplace, such as operation of insurance affordability programs for those who are enrolled, and oversight of issuers of Marketplace Health Plans
- Respond to any consumer feedback or complaints you file
- Combat fraud and abuse in the federal health care system
- Respond to suspected or confirmed breaches of Marketplace security or confidentiality of information
Also, federal law (like the Privacy Act and Social Security Act) may require or permit us to share information we collect or maintain about you for other purposes. More information on the ways your information is allowed to be used and shared can be found in the Health Information Exchange Program (HIX) System of Record Notice 09-70-0560.
Who can my Marketplace information be shared with and why?
We will only share your information as needed and described in the System of Records Notice or as authorized or required by law. Examples of when we may disclose your information to agencies or people who need the information for specific reasons are provided below. For more information, review the System of Records Notice.
- When you apply, we verify the information you provide with these organizations and agencies to determine your eligibility to purchase a qualified health plan through the Marketplace and, if you choose, for help paying for health coverage:
- Social Security may verify your Social Security Numbers and citizenship status.
- The U.S. Department of Homeland Security may verify your immigration status and/or naturalized citizenship status.
- The Internal Revenue Service (IRS) may verify your household income and family size; the income of household members may also be verified with the Social Security Administration and with a consumer credit reporting agency
- A consumer credit reporting agency may verify your employment information.
- The employers listed on your application may verify your eligibility for employer-sponsored health plans.
- The State Medical Assistance (Medicaid) office, the Children’s Health Insurance Program (CHIP), the U.S. Department of Veterans Affairs, Medicare, Peace Corps, U.S. Department of Defense (for TRICARE), U.S. Department of Health and Human Services, the Office of Personnel Management (OPM), and the Small Business Health Option Programs (SHOP) that operate in your state may verify your eligibility for and/or enrollment in health coverage programs.
Not all applicants will need to provide all this information. For example, you’ll be asked about your employment, income, and enrollment in health coverage only if you want help paying for health coverage.
- When you select “Female” or “Male” in response to the required application question about sex, we:
- Don’t verify this information with the organizations listed above.
- May share this information with the insurance company when you enroll in a plan.
- May share this information with agencies like your state Medicaid program or the Children’s Health Insurance Program (CHIP) and others as authorized by law to run the Marketplace program.
- Use the information to determine whether you get additional application questions about pregnancy.
- You may decide to give permission to organizations or people who can communicate with the Marketplace about your application for such needs as resolving inconsistencies or ensuring complete and accurate applications. Depending on your permission, they may include:
- Your authorized representatives
- Your Marketplace-certified agents, brokers, certified enrollment partners, or the insurance company that issues your Marketplace health plan
Each application filer confirms that he or she is authorized to share information for everyone on the application. That way, the Marketplace has permission to share your information with your application filer.
- Once you select coverage, we'll use your information for purposes such as:
- Notifying employers on your application if you’re eligible for certain insurance affordability programs (advance payment of the premium tax credit or cost-sharing reductions).
- Transferring your enrollment information to the appropriate organization or agency. This might be the issuer of the Marketplace plan that you selected, or a Medicaid or CHIP agency.
- Making reports to the Internal Revenue Service about your enrollment in a qualified health plan through the Marketplace and about your eligibility for advance payment of the premium tax credit, cost-sharing reductions, and/or a certification of exemption from the individual responsibility requirement(s)
- If you choose to submit an appeal, the information from your application and your appeal may be shared with federal and state agencies listed under #1 above to process your appeal.
- To maintain Marketplace operation, we work with the following groups and may therefore share your information with:
- Contractors that perform functions for the Marketplace to accomplish the specific functions they’re engaged to perform.
- Other federal, state, or local government agencies to combat fraud, waste, and abuse and to respond to concerns about the security or confidentiality of information.
- Insurance companies that issue Marketplace plans and also the IRS, for the ongoing administration of advance payments of the premium tax credits and cost-sharing reductions, if applicable to you.
- Issuers of qualified health plans and states, if you complain to us about a qualified health plan or an issuer, to notify the issuers and state about the complaints.
Do I have to answer the questions on my Marketplace application?
You don’t have to give personally identifiable information (PII), including Social Security Numbers. However, if you don’t give this information, it may delay or prevent the Marketplace from performing all functions, like telling you about getting help paying for coverage, or determining your eligibility for benefits, programs or exemptions.
Be sure to provide correct information. Anyone who fails to provide correct information or who knowingly and willfully provides false or untrue information to the Marketplace may be subject to a penalty and other law enforcement action.
Do I have to provide Social Security Numbers for people listed on my application?
People who apply for health coverage need to provide a Social Security Number if they have one. An application filer must also provide the Social Security Number of any tax filer who isn’t applying for health coverage if the tax filer’s tax information will be used to verify the household’s eligibility for help with paying for health coverage. We encourage other people not applying for health coverage to provide their Social Security Numbers to speed up the application process, but they aren’t required to provide one. We use Social Security Numbers to check income and other information to determine who’s eligible for help with health coverage costs. For help getting a Social Security Number, visit Social Security at ssa.gov, or call 1-800-772-1213. TTY users should call 1-800-325-0778.
Can people who aren't U.S. citizens apply for health coverage through the Marketplace?
Lawfully present immigrants can apply for health coverage. We’ll only use the immigration information you provide, and we get from other sources to determine eligibility and administer Marketplace and insurance affordability programs. People who aren't applying for health coverage don't need to provide their citizenship or immigration status. Use of coverage obtained through the Marketplace or insurance affordability programs won't affect a person who's in the process of becoming a lawful permanent resident (green card holder) and won't be considered a public charge. A public charge is an individual who is likely to become primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance or institutionalization for long-term care at government expense.
What should I do if I think my eligibility results are wrong?
If you don’t agree with what you qualify for, in many cases you may be able to file an appeal.
You can appeal eligibility to buy Marketplace plans and to qualify for enrollment periods. If you’re applying for help paying for coverage, you may also have the right to appeal eligibility for the premium tax credit, cost-sharing reductions, Medicaid eligibility, and CHIP eligibility. If you qualify for the premium tax credit or cost-sharing reductions, you can appeal the amount you’re eligible for.
Review your eligibility notice to find appeals instructions for each person in your household, including how long you have to file an appeal.
Tips for filing an appeal:
- 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.
- You may be able to continue your coverage in your Marketplace plan (or enroll in coverage) while your appeal is pending. If eligible for coverage, complete your enrollment 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).
- The decision of an appeal could impact coverage for other members of your household.
Depending on where you live and your eligibility results, you may be able to file an appeal through the Marketplace or you may have to file an appeal with your state. Check how to appeal based on where you live.
What are my rights regarding my information in the Marketplace?
- You, and people you give permission to, may see and request a copy of the personally identifiable information we collect and maintain about you.
- You may question if the information we have about you is correct.
- You have the right to ask for an accounting of the entities or people to whom the Marketplace has disclosed your information.
- If you have any questions or don't understand how we use your information, contact the Marketplace Call Center.