There are a variety of scenarios in which you can appeal the marketplace’s decision, and get the appeals process expedited. The appeals process used by HealthCare.gov – the enrollment platform used in 33 states – is outlined here. If you’re in Washington, DC, or one of the other 17 states with state-based marketplaces, your exchange will have its own process by which you can appeal a decision that the marketplace makes.
If you believe you’re eligible for a special enrollment period and the marketplace says you’re not, you might find some helpful resources in our guide to special enrollment periods. In most cases, we link to the applicable federal regulations, which may help you when you’re providing supporting documentation for your appeal.
If a financial assistance eligibility determination doesn’t work out the way you expected, our guide to premium subsidies might be useful in understanding what’s happening. We also have a detailed explanation of how premium subsidy amounts are determined based on the percentage of your income that you’re expected to pay for your coverage.