As the Federal Facilitated Marketplace evolves, we are starting to see the processes put into place to resolve issues. Here you can find the appeal request form. You can request an appeal if you think there was a mistake about you or your family members’ eligibility.
Here are some of the reasons you may want to file an appeal:
- A denial of eligibility for purchasing health coverage, including eligibility to purchase a catastrophic health plan through the
- A denial of eligibility for tax credits or cost-sharing reductions to help pay for coverage through the marketplace.
- The amount of tax credits or cost-sharing reductions you were determined eligible to receive through the marketplace.
- A denial of eligibility for a marketplace enrollment period.
- A denial of eligibility for an exemption from the individual responsibility requirement.
The main issue we see for filing an appeal would be the denial of coverage for Indiana Medicaid, Hoosier Healthwise and Health Indiana Plan (HIP). We have had a lot of Hoosiers get very frustrated with the subsidy application for multiple of reasons, the big one being that they are being told they or their dependents are eligible for one of these programs. These programs are based on income, so if your household income is under the 250% of Federal Poverty Level (FPL) then your children could qualify for Hoosier Healthwise.
There have been a lot of situations where the children would not qualify for such programs but would have to reapply for Hoosier Healthwise. Since it takes 45 -90 days to get a determination form Hoosier Healthwise this has been frustrating to many parents.
Another big issue concerns adults that have low income but that do not qualify for Medicaid. On the exchange, these people are being told they are not eligible for subsidy assistance. This has been very frustrating for a lot of people in Indiana.
Now, we have an appeal process for the marketplace set up. How long this process could take we don’t know yet. You will see in the PDF that we have to mail the appeal letter in. We hope that the marketplace comes up with a solution to email, fax or upload the document directly.
We do think that the processes for the exchange will continue to get faster and easier. As always, if you are frustrated, please contact us so that we can find solutions for you!