When you interact with the Health Insurance Marketplace, you are interacting with a federal system. While most enrollments go smoothly, mistakes happen. Whether it is an incorrect calculation of your subsidy, a denial of a Special Enrollment Period, or an issue with your eligibility status, you have the right to challenge these decisions.
If you receive a notice you disagree with, don’t wait. You generally have 90 days from the date of the notice to file your appeal.
You can file an appeal online, by mail, or by fax. The most efficient way is through your Healthcare.gov account. You will need to submit:
The Marketplace will review your request. In some cases, they may identify a simple data entry error and resolve the issue quickly without a formal hearing.
If the initial review doesn't resolve the matter, you have the right to a formal hearing. This is an informal, semi-legal process where you (or an authorized representative, like a licensed agent) can present your case to an appeals officer. You can do this by phone.
You will receive a written notice of the decision. If the appeal is granted, the Marketplace will correct your records, which may result in retroactive coverage or a change in your monthly subsidy amount.
Under the Affordable Care Act, you are protected by several "Consumer Bill of Rights" clauses:
Yes. To avoid a gap in coverage, continue paying your premiums while the appeal is pending. If the appeal results in a lower premium, you may be eligible for a credit or refund.
No. Filing an appeal is free.
While we are licensed to guide you through the enrollment and documentation process, formal legal appeals are handled by the federal Marketplace. However, we can provide you with the documentation and data you need to build a strong case.
This website is operated by Jena Holdings LLC, FL License # L134910 and is not the health insurance marketplace website. We Invite application for insurance in states where we maintain our agency/broker licenses and appointed for each state that requires a license to conduct health insurance sales and services.We are required to comply with all applicable federal laws, including 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 Marketplace plans being offered in your state through our partner websites. To see all available data on Marketplace plan options in your state, go to the Health Insurance Marketplace website at HealthCare.gov. If you have questions or concerns, please contact us at support@coverplushealth.com
