To file an appeal, complete and submit the form online , or download and complete the form for your state and mail it to the Marketplace.
Appeal Request Form for the following states:
- Alabama
- Alaska
- Louisiana
- Montana
- Virginia
- West Virginia
- Wyoming
Appeal Request Form for the following states:
- Arizona
- Arkansas
- Delaware
- Florida
- Georgia
- Hawaii
- Illinois
- Indiana
- Iowa
- Kansas
- Michigan
- Mississippi
- Missouri
- Nebraska
- New Hampshire
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Wisconsin
Appeal Request Form for the following states (Use this form only after you’ve used up all of your eligibility appeal rights with your state):
- California
- Colorado
- Connecticut
- District of Columbia
- Idaho
- Kentucky
- Maine
- Maryland
- Massachusetts
- Minnesota
- Nevada
- New Jersey
- New Mexico
- New York
- Pennsylvania
- Rhode Island
- Vermont
- Washington
