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Marketplace notices are official documents the Marketplace generates for a consumer’s subsidy application. HealthSherpa makes Marketplace notices visible & keeps them organized so agents can quickly access them after an application is submitted.
In this article we’ll cover:
Marketplace notices do not display within HealthSherpa Enrollee Assistance Full-Service account types.
Where to find Marketplace notices
Select the consumer’s name on the Clients page to open their consumer record.
The Details tab is the default view when an agent opens a consumer record from the Clients page.
Agents can only service an application and view the most up-to-date application information when they have an active Enhanced Direct Enrollment (EDE) sync to the application.
Scroll to the Marketplace notices section to view & download notices associated with the consumer’s subsidy application.
Marketplace notices display in the order they’re received from the Marketplace.
Types of notices that may appear
Marketplace notices can include many different notice types generated by the Marketplace.
Notices that may appear include:
Insufficient documentation
Documentation deadline passed
Documentation follow-up resolved, or escalated
Failure to Reconcile Taxes
Periodic Data Matching Notification
Message from Marketplace Eligibility Support
When a follow-up changes status (for example, insufficient documentation or resolved), a new Marketplace notice may appear with details about the update.
Not all consumers will have the same notices. Marketplace notices display based on what the Marketplace generates for the consumer’s submitted subsidy application.
Understanding the Marketplace Eligibility Notice
A Marketplace Eligibility Notice is an official letter from the Marketplace that is generated each time a consumer’s subsidy application is submitted.
This notice includes:
Coverage eligibility for the applicant and their household
Financial assistance the household qualifies for, including advance premium tax credit (APTC) and cost-sharing reductions (CSR)
Any follow-up actions needed to satisfy Data Matching Issues (DMIs) & Special Enrollment Period (SEP) Verification Issues (SVIs)
The Marketplace Eligibility Notice is available from the Marketplace notices section as well as during the application flow after the subsidy application is submitted.
Frequently asked questions
What is an Enhanced Direct Enrollment (EDE) sync?
The Centers for Medicare & Medicaid Services (CMS) grants Enhanced Direct Enrollment (EDE) permission to agents for their enrollment submissions. This permission enables data syncs between the Marketplace and HealthSherpa.
When an application has an EDE data sync, the HealthSherpa dashboard shows the most up-to-date application information and the application can be serviced.
Can Marketplace decisions be appealed?
Consumers who disagree with a decision the Marketplace makes on their application (for example, eligibility for coverage, subsidies, Medicaid or Children’s Health Insurance Program (CHIP), or cost-sharing reductions (CSR)) have the right to file an appeal. Appeals generally must be filed within 90 days of the date on the Marketplace Eligibility Notice.
To file an appeal, consumers can follow these steps:
Get the Marketplace notice: Review the eligibility or coverage notice received from the Marketplace to understand the reasoning behind the decision made.
Complete an appeal request form: Fill out the official Marketplace appeal request form. Consumers can also write a letter that includes their name, address, and details of the decision being appealed.
Consumers can either file online through their Marketplace account or download and submit the paper form.
Appeal forms & instructions
Marketplace Appeal Request Form A fillable/downloadable PDF
Quick steps:
If the consumer has a HealthCare.gov account, they can file the appeal online via the account’s Eligibility & appeals section, or download and complete the Marketplace Appeal Request Form. The form page includes mailing/fax instructions.
If consumers need help, call the Marketplace Appeals Center at 1-855-231-1751 (TTY 711) for appeal questions or to confirm receipt.
Send the appeal request: Mail or fax the appeal request to the address or number listed on the Marketplace notice. Consumers should keep a copy for their records.
Await confirmation: The Marketplace Appeals Center will contact the consumer to confirm the appeal, review the appeal, and explain next steps. Consumers will receive instructions if additional information or documents are needed. In some situations, consumers can request that their eligibility continue (continued coverage) while the appeal is pending.
Additional resources
For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Agent_Support@HealthSherpa.com, or by chat directly from your account.