Marketplace Appeals Length and Proving Income

The marketplace has taken away the subsidy given to me, the only one in my household with an ACA plan, because they claimed to not get the required paperwork/uploads they requested. The thing is: they DID get those things. three times over. Multiple uploads to the website, twice physical paper copies sent to the KY address. Because of these false claims and/or technical issues on THEIR end, I am facing a $275 increase in my premium. I filed an appeal, they sent me a letter detailing what they needed and when it was needed by, I provided everything I could -did you know, it is nearly impossible to prove you’ve had no income at all? Its a nightmare. All the forms they request do not exist for me. What do I do? They don’t care.- paper and form-wise for myself and my father whom I am a dependent of, sent registered mail with tracking and I KNOW They received the envelope! USPS tracking said so, I saved the record of it too!

The thing is, I’ve heard nothing since. Not a word. This all started March 16th. They already took my subsidy away immediately for April, and now May and now I owe my insurance company $857 to keep my coverage going. I’ve only had it since January 2015! I was so happy to get help to break the cycle of “not healthy enough to work, can’t earn to get insurance, can’t get healthy without insurance” but it’s turned into a complete nightmare right in the middle of it.

In Summary: How long do appeals take? What do you do to prove you have no income of your own and thus do not HAVE the forms they request? Do I have to get a lawyer to prove to them that I had no income last year?

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Chandran Balakrishnan

How to make an appeal to Appeals department for refund of excess amount of premium paid pending submission of documents of household income. Having verified the household income, the earlier paid excess subscription in the month of April 2017, neds to be refunded. How to make appeal for refund of excess subscription already paid


If you need to appeal assistance amounts you should contact directly for guidance.


They took my subsidy away as well. I have had the same issue I uploaded my tax documents and they claim they didn’t get it so I did it again but when I went to pay my premium it says I owe $1600… REALLY!!!! I’m barely able to afford the premium of $175. I have appealed but I haven’t heard anything yet. If my premium isn’t paid by the 25th of the month my family will be without coverage and my husband is diabetic…. It’s an awful feeling.


The OP can prove INCOME with the documents listed, but how can he prove NO INCOME? It’s called “proving a negative” and it can’t be done. The tax return won’t work because he’s claimed on his father’s return; he won’t have a W-2, 1099 or pay stub if he’s not working; he won’t get an investment fund letter, proof of tribal income, unemployment benefit letter, alimony letter, military leave statement, agricultural certificate or financial aid form if he’s not getting any income or assistance from those sources. All of those sources will only tell you what they’re giving, not what they’re not giving. Even a letter from an employer will only be able to say he no longer works there, not that he doesn’t work somewhere else.

Good luck to you, friend. I’m glad my version of this catch-22 is only regarding my high-school-aged child no longer having a summer job. In my case, Maryland will accept a signed affidavit (or so they say), and the stakes are much lower. I wish the best for you.


The marketplace ask you for your yearly income in the beginning of the year. If you make any phone calls or inquiries about anything about in your application they will assume that your income has changed and make a whole new application. Once they make a whole new application they decide that they need to have the information that verifies your income immediately and if they don’t receive it they will cancel your tax credit and charge you full price for your premium. Once they do that you are now responsible to pay the full price of that premium or your health insurance will be terminated. Once they terminate your insurance you are now no longer eligible to reinstate your policy through the marketplace because you have lost your policy due to failure to pay your premium this is all an entire circle of confusion and deceit designed by the marketplace to create fines and hassles for the consumers because they don’t have insurance even though they have their tax credit. When they have determined that you cannot afford to get insurance through your employer they are the only place that can ensure you even though they refused to give you insurance because you’ve lost your insurance because you couldn’t afford to pay a quadruple premium now you are at their mercy and they have the right and the ability to completely ruin your life for about 7 months this is a complete scam it’s always been a scam it’s never been installed to give low-income families health insurance it’s only in place to give the health insurance Marketplace employees jobs and insurance that is all do you realize that the employees of the marketplace have free HealthCare coverage and they don’t even have to be American citizens.


If you lose your tax credit and your premium triples or quadruples and you are unable to pay it guess what you know will be terminated for failure to pay your premium guess what again you will also not be able to be reinstated to that policy or any other policy due to you have been terminated for not paying your premium and they will not give you another insurance policy through the marketplace that is what they do not tell you. Even if the tax credit was removed by a mistake on their part that does not matter you are completely screwed out of your insurance and it will never be an expedited process for you to be reinstated to any insurance they will make your life a living hell.


Oh really. Because I filed for an expedited appeal in April. I was told my appeal was, indeed expedited, but it is now July. My coverage was cancelled, with no warning, when I changed my address. This system is a travesty, and there is no one to appeal the appeals process!


NO NO NO NO NO. This doesn’t even come close to answering my problem. You get a big fat F — Failed. Stinko. Rotten.
I have cone 15 calls to the marketplace and some to the insurer. Who do I need to speak to? The decision makers are not available to hear the argument I have. I have been trying to appeal since December 2015. I have sent at least 3 appeals and 6 escalations. The problem is this….
One error and misinformation after another:
1. I called insurance company to stop my coverage and wasn’t told I had to call MP. I did not understand as most of the public still does not understand how this works.
2. I was auto enrolled because mail was never delivered to me. I thought I was already disconnected from the MP.
3. Every time I appeal or send an escalation the same answer comes back I am told the 1095-A will not be changed because it’s consistent with information you have from the marketplace and the insurers records.

Those records are wrong. They are false, I am a victim of circumstances beyond my control. Is there no human being in the entire operation of the marketplace that can understand this issue?

This is a joke. . . I am now stuck with a huge tax bill because of the marketplace. HOW CAN THIS BE CALLED AFFORDABLE HEALTH CARE? Wrong. it is Wrong.


I too have a problem with the Market Place. We applied in November 2014 got the paperwork that said we were in. Then I sent in the forms for both my husband and I. Got a call in February that I needed to send everything yet in again. So I copied it and sent it off again to KY. In March I got a letter that said I was being canceled because of not having sent the proper paper work in. They said the best thing to do, since my husband is in need of medical attention, was to reapply using the same application number but it would start April first. and to send in the proper paper work again. So this time I sent it in Certified Mail, for proof I got a signature. They have sent in many escalations to get back the January effective date and keep saying it’s not them it’s the insurance company. I have been fighting this situation ever since.
Then on January 7th of 2016 I call to get things cleared up yet again because now I found out that since I got a NEW insurance, because I couldn’t afford the last one, that when I applied I was to have them cancel the old one. How can they be so stupid!!!! It wasn’t me on the computer but on the phone, and I told them I was changing insurances. So they didn’t cancel so now I have to pay for January on both insurances. After 3 hours on the phone I got a Supervisor who said she would fix everything and that they would cancel the first insurance for me and send in escalations for that and for the 2015 screw up again. Thinking Wow a real person with authority I hung up.
Boy was I surprised when today the 11th of January I get a call at 7am letting me know that the escalation have gone through and that the insurances were canceled. That word insurances hit me wrong. I asked if my 2015 was canceled, yes they said. So now I have the 2016 insurance? No she said it is also canceled. So after 20 minutes of arguing I have NO insurance for 2016. And my husband who is scheldual for surgery in a week will have to wait it out till this gets straightened out yet again. Which by their means could take a year.
She signed us up with the same application number, yet again. but it won’t take effect till February.
According to her the Supervisors put in the escalations which is given to a Case Worker, her, but that certain ones, like insurance escalations, are given to Case Workers that you can’t talk to that only work with computers
I don’t know about the rest of you but the idea of going through this again next year scares me. I’m sure the Federal Government will get involved and try to fine me for the months that are screwed up, even though I have documentation of payments and letters of enrollment.
Where is there a name and number we can get ahold of someone who cares about all this??????


Both the IRS and HealthCare.Gov (or your state Marketplace) can be contacting in the event of the issue. We never really got a golden fix-all answer last year outside of this. I would assume that the system will be much tighter this year (as that is usually the way it goes with tax programs like this).


I have sent in documentation and never have received affirmation. Our only income is social security and withdraws from our IRA. So I can only supply them with a 1040 copy. I believe the Marketplace is destroying received income verification documentation. They have a serious problem and not addressing it. I received an email threat from them last week even though I sent in documents in early January. Someone is deliberately playing games and destroying the mailed in documents in my opinion.


I had no problem with the 2014 subsidies. Despite the flaws in the website, I got my subsidies and only had a problem with getting the correct 1095A (which they eventually sent after several calls).

On the other hand, 2015 has been the absolute worst. Our cost-sharing was canceled in March because I did not supply sufficient proof of income — so I assumed, because their form letters are so ambiguous as to what they need. I submitted an appeal and reapplied. The expedited appeal was found in my favor. I uploaded tons more documentation, but for every upload, I get that same dreaded useless letter.

I finally uploaded a PDF of the appeals letter which directed the Marketplace to effectuate the coverage immediately, but they haven’t accepted that, either (no explanation and thanks to a major defect on the site, I don’t get messages online and have to wait for snail-mail, which takes an extra week).

No one at the Marketplace has been able to help. In fact, they express their own frustration because the group that reviews the documentation won’t talk to them or consumers. I’ve even enlisted the Appeals group to help — they confirmed all my documentation I uploaded is there — but their hands are tied.

Why is there an appeals process if the judgment in one’s favor doesn’t lead to action? Why doesn’t the Marketplace have access to the people reviewing the documents? Why does the review group only send form letters instead actually saying what is missing or why they’re rejecting the submittal? Why is it I’ve reported the messaging problem multiple times and yet it still is a problem?

I realize that this all may be moot if the SOTU guts the ACA (I’m in a state without a state exchange). I refuse to go on Medicaid, but if I have to pay full freight for our insurance policy, that will be another $7200 coming out of our savings this year bringing the premium total to over $12,000!

The ACA is a great idea, but poorly implemented. Another example of how the government can screw up a good thing due to incompetence, malfeasance, and overall idiocy.

Anyway, I have until July 8th to get this resolved or their going to cancel my subsidies again. This is so maddening and disrupted my peace of mind for way too long. Meanwhile, I can’t fully concentrate on getting our new business running for everything I have to do for this bloody health insurance!


Sorry to hear about that experience, but thank you for sharing. I’m sure this will be helpful insight for someone else having the same issues.

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