If you think Explore Health made a mistake about your health coverage or financial help, you have the right to ask for an appeal.
An appeal is a request to review a decision again.
When you can file an appeal
You usually have:
- 90 days from the date on your eligibility notice to file an appeal
- 95 days for citizenship or immigration-related issues
If you miss the deadline, you may still be able to appeal if you have a good reason.
How to file an appeal
You can file an appeal:
What decisions can be appealed
You may appeal decisions about:
- Eligibility for health coverage
- Premium tax credits or financial help
- Cost-sharing reductions
- Special Enrollment Period eligibility
- Coverage start dates
- Plan cancellations or terminations
- Coverage reinstatement requests
What decisions usually cannot be appealed
Some issues are handled directly by your insurance company or the IRS and cannot be appealed through Explore Health.
These may include:
- Premium refunds
- Claim payment denials
- Information on your 1095-A tax form
- IRS decisions about tax credit repayment
Fast-track appeals
You can ask for a faster appeal if waiting could seriously affect your:
- Health
- Safety
- Ability to get medical care
This is called an expedited appeal.
Help during the appeal process
You can:
- Represent yourself
- Choose someone to help you, like a family member, friend, assister, or authorized representative
Keeping your coverage during an appeal
In many cases, you can keep your current coverage and financial help while your appeal is reviewed.
However, if the final decision finds that you were not eligible for certain savings, you may need to repay some financial help at tax time.
If your appeal is approved
If Explore Health decides in your favor:
- Your eligibility may be updated
- Your financial help may be restored
- Your coverage may be corrected or reinstated
Oregon Health Plan (OHP) appeals
If your appeal involves Oregon Health Plan (OHP) eligibility, your information may be shared with the Oregon Department of Human Services (ODHS) for review.
For OHP appeal questions, contact Client and Enrollment Services:
Hardship exemptions
Some people may qualify for a hardship exemption because of financial hardship or other difficult situations.
Hardship exemption requests are handled through: HealthCare.gov
You may also be able to request certain hardship exemptions when filing your federal taxes with the IRS.