Webinar:
April 2022

Marketplace Appeals Process

This Beyond the Basics webinar was presented in partnership with the National Health Law Program on April 28, 2022. 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.

↓ View Presentation Slides (PDF)

Webinar

Jump To:

Which Issues Can Be Appealed & Where

  • Marketplace appeals
  • Marketplace call center casework
  • Insurer appeals
  • State Department of Insurance appeals

How to Request an Appeal

  • Requesting a marketplace eligibility appeal
  • Timeframes for requesting an appeal
  • Requesting to continue APTC during an appeal
  • Valid vs invalid appeals

Role of Assisters in the Appeals Process

  • Who can assist in an appeal?
  • How assisters can help

Appeals Process & Implementing Eligibility Decision

  • First stage of an appeal: informal resolution
  • Second stage of the appeal: formal resolution/hearing
  • Expedited appeals
  • Implementing the eligibility appeals decision

No Surprises Act Appeals

Additional Resources

Marketplace Appeals Fact Sheet

Health Reform: Beyond the Basics is a project of the Center on Budget and Policy Priorities designed to provide training and resources that explain health coverage available through Medicaid, CHIP, and the Marketplace. It is aimed at navigators, advocates, state and local officials and others who help consumers get and keep their health coverage.

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Beyondthebasics@cbpp.org

Robert Wood Johnson Foundation

Support for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

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