Key points
- A Marketplace appeal is for decisions the Marketplace made about you: whether you can enroll, your tax credit, your special enrollment period or an exemption.
- It is not the way to challenge your insurance company's refusal to pay a claim. For that, appeal to the plan, then ask for independent review.
- You generally have 90 days from the date on the eligibility notice. A state-run marketplace may use a different deadline of at least 30 days.
- Check the date on your notice, which controls.
The word “appeal” is used for two different processes when you have a Marketplace plan. This page is about one of them: asking the Marketplace to change a decision it made about you. If your insurance company refused to pay a claim or refused to approve care, this is not your process. Skip to “If your problem is a claim denial” below.
What this means
The Marketplace, also called the exchange, is the place where you applied and enrolled. It decides things like:
- whether you are eligible to buy a plan;
- how much premium tax credit or cost-sharing reduction you get;
- whether you qualify for a special enrollment period;
- whether you qualify for an exemption; and
- whether it gave you a timely notice of an eligibility decision.
You can appeal those decisions to the Marketplace’s appeals office. The insurance company is not a party to that appeal.
If your problem is a claim denial
A Marketplace appeal is not the way to challenge a health plan’s claim denial, a plan’s decision to end your coverage, or a premium billing error. HealthCare.gov says to take those to the plan. That is the plan’s internal appeal first, and then external review, which means review by outside reviewers.
For a claim denial, go to Marketplace and individual plans: the appeal path. You will have at least 180 days after you receive the denial to appeal to the plan, and then at least four months after the final denial to ask for independent review. Check the date on your notice, which controls.
If you filed a Marketplace appeal by mistake, do not wait for it to fail. File the plan appeal inside the plan’s deadline now.
What to do
- Find the eligibility notice and its date (you). The 90 days run from that date.
- Decide whether to ask for the old eligibility to continue (you). If the appeal is about a change to eligibility you already had, you can choose to keep your earlier level of eligibility, including advance premium tax credits, while the appeal is pending. HealthCare.gov warns that if you lose, tax credits you received may have to be repaid when you file your taxes.
- File the appeal by the method for your state and account (you). The appeals office must accept requests by phone, by mail, in person where it can, and online. HealthCare.gov has a tool that shows the right form and method for your state and account.
- Say if you need care urgently (you and your doctor). An expedited appeal is available when there is an immediate need for health services because the standard process could seriously harm your life, health or ability to function. If the request to expedite is denied, the appeal goes on the standard track and you must be told promptly.
- Expect informal resolution first (you). The federal process offers an informal resolution and then a hearing if you are still dissatisfied. The written decision is due within 90 days of your request, as administratively feasible.
- If you win, ask for the start date you need (you). A winning decision can take effect going forward or, if you choose, retroactively to the date coverage would have started under the correct decision.
The rule
The deadline to appeal a Marketplace eligibility decision is 90 days from the date of the eligibility notice. A late appeal may be accepted if the delay is explained. (Title 45 of the Code of Federal Regulations (CFR), section 155.520(b))
Watch for
- A different deadline in some states. A state-run marketplace may use its state Medicaid fair hearing deadline instead, if that deadline is at least 30 days. Read your notice and your state page on the state pages.
- A second step. A decision by a state-run marketplace’s appeals office can be appealed to the federal appeals office within 30 days.
- Medicaid and children’s coverage. In Alabama, Alaska, Missouri, Montana, North Carolina, West Virginia and Wyoming, a Marketplace finding that you are not eligible for Medicaid or the Children’s Health Insurance Program can also be appealed through the Marketplace. This list was shown on HealthCare.gov on 11 November 2026.
- Federal address and fax. This site has not verified the mailing address and fax number for the federal Marketplace Appeals Center. Use the tool and the notice on HealthCare.gov rather than an address from an older guide.
- Changing rules. This site has not checked the status of the 2025 Marketplace rule changes and related lawsuits, or of enhanced premium tax credits for 2026 and 2027. These affect eligibility decisions. Check HealthCare.gov for what applies to your notice.
What next
- Marketplace and individual plans: the appeal path covers a claim denial from your plan.
- Appeal, complaint, grievance and external review explains how the processes differ.
- Where to get free help lists people who help with eligibility problems at no cost.