DWQA QuestionsCategory: Marketplace Verification and AppealsHow do I appeal a Health Insurance Marketplace decision?
HealthTNHealthTN Staff asked 4 years ago

How do I appeal a Health Insurance Marketplace decision?

1 Answers
HealthTNHealthTN Staff answered 4 years ago

You can request an appeal of any Marketplace decision, including decisions about

  • Your eligibility to buy coverage in the Marketplace
  • Your eligibility for, or the amount of, premium tax credits or cost sharing reductions
  • Your eligibility for an exemption from the penalty for not having health insurance
  • Untimely (late) notice from the Marketplace about a decision

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.

This website is operated by Continental Health Alliance, LLC DBA HealthTN.com and is not the Health Insurance Marketplace website. In offering this website, HealthTN.com is required to comply with all applicable federal laws, including the standards established under 45 CFR 155.220(c) and (d) and standards established under 45 CFR 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans being offered in your state through the Health Insurance Marketplace website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace website at HealthCare.gov.
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