Marketplace Appeals Process

This Health Reform: Beyond the Basics webinar was presented in partnership with the National Health Law Program on February 16, 2021. Mara Youdelman, Managing Attorney at the National Health Law Program, provided information on marketplace appeals, detailing what decisions can be appealed, how to file an appeal, and ways to expedite the appeal process.

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Overview of Marketplace Eligibility Appeals

What Determinations Can Be Appealed

• CMS Casework
• Insurer Appeals
• State Department of Insurance Appeals
• Marketplace Appeals
• SBM Appeals to FAE
• When a Consumer Can Appeal
• Examples

How to Request an Appeal

• Requesting a Marketplace Eligibility Appeal
• Timeframes for Requesting Appeals
• Requesting to Continue Tax Credits During an Appeal
• Who Can Assist in an Appeal
• Role of Assisters in the Appeals Process
• Examples

Appeals Process & Implementing Eligibility Decision

• First Stage of an Appeal: Informal Resolution
• Second Stage of the Appeal: Formal Resolution/Hearing
• Expedited Appeals
• Eligibility Appeals Decisions
• Implementing the Eligibility Appeals Decision
• Examples