There are several notices the Marketplace sends to your client related to their subsidy application. HealthSherpa automatically stores these for you and allows you to easily view these notices directly from your consumers' Clients details page.
Note: you will need to have EDE enabled in order to access a Clients Details page.
From the consumer's Clients Details page, scroll to the Marketplace notices section. Here, you can download any document you wish to view by selecting 'Notice' next to the desired document.
Types of Marketplace notices that populate
Eligibility Determination Results notice
This shows the official subsidy result, and the official eligibility determination.
Follow-ups notices
Follow-up notices can include:
Followups Required to Enroll
Followup Documentation Insufficient
Followup Resolved
Followup Deadline Passed
Followup Escalated
When a Follow-up document changes status (e.g. insufficient documentation, completed), a Marketplace notice will generate containing details related to the status change.
1095 notices
IRS 1095 A Initial Form
IRS 1095 A Corrected Form
IRS 1095 A Voided Form
And more
Consumer Confirmation Message
Marketplace Open Enrollment Reminder
Message from Marketplace Eligibility Support
Data Sources Down
Inbound Account Transfer
Outbound Response Account Transfer
Failure to Reconcile Taxes
Failure to Reconcile Taxes Final Notice
Periodic Data Matching Initial Notification
Periodic Data Matching Final Notification
Frequently asked questions
Where does HealthSherpa get these notices?
HealthSherpa gets these notices from CMS via EDE integration.
How are these notices organized?
The notices for your client will appear from newest to oldest.
Will these notices include emails my client receives from the Marketplace?
No, emails are separate from notices.
Can Marketplace decisions be appealed?
Consumer who disagree with a decision the Marketplace makes on their application (e.g. eligibility for coverage, subsidies, Medicaid/CHIP, cost-sharing reductions) have the right to file an appeal. Appeals usually must be filed within 90 days of the date on the Marketplace 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. Consumer's 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 (HealthCare.gov): https://www.healthcare.gov/marketplace-appeals/appeal-forms/. HealthCare.gov
Direct PDF (Marketplace Appeal Request Form A — fillable/downloadable): https://www.healthcare.gov/downloads/marketplace-appeal-request-form-a.pdf.
Quick steps:
If the consumer has a HealthCare.gov account, you can file the appeal online via your 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. Consumer 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. Additionally, Consumers will receive instructions if additional information or documents are needed. Note: In some situations, consumers can request that their eligibility continue (“continued coverage”) while the appeal is pending.