Step 5: Eligibility determination

Based on the information you submit on the application; the Marketplace will provide an eligibility determination. The insurance program that you qualify for along with any financial assistance offered will automatically be determined and displayed within your account on the Eligibility tab.

Any actions you need to complete to finalize eligibility are highlighted at the top of the Eligibility tab.

The different insurance programs available through the Marketplace are Medicaid, Child Health Plus, the Essential Plan, or a Qualified Health Plan.

If you are eligible for a Qualified Health Plan, you may also be eligible for financial assistance towards your monthly health insurance premium and/or your out-of-pocket expenses when you use health care services.

If you disagree with the eligibility determination, you can call the Marketplace helpline at 1-855-355-5777 (TTY: 1-800-662-1220) to discuss your concerns. If you are not satisfied with the result of the informal resolution process you may request a formal appeal if the time limit for requesting an appeal has not ended. You can also ask for an appeal without using the informal resolution process.