We Received a Marketplace Notice—Now What?

Marketplace notices have started to arrive, but what do you do with them? It depends!

A Marketplace notice informs you that a person receiving a subsidy for individual health coverage purchased through the Marketplace has listed you as their employer.

No action is needed if you know of no reason why the employee should not receive a subsidy.

If you believe the employee should not be receiving a subsidy, you can file an appeal with Health and Human Services. For example, if you offered the employee affordable coverage that met the minimum value standard, the employee is likely not entitled to a subsidy to help pay for individual Marketplace coverage.

Note that you are appealing the employee’s eligibility for the subsidy only. You are not appealing any potential penalty to your organization under the ACA Employer Mandate. Only the IRS can determine which employers are subject to Employer Shared Responsibility (penalty) Payments. Even though an employer receives a marketplace notice, it doesn’t mean a penalty will be charged. The IRS will determine, independently, if the employer is liable for a section 4980H penalty.

Employers have 90 days from the date of the notice to appeal subsidy determinations. To appeal, complete and sign the HHS form, and mail it with copies of any supporting documents to:

Health Insurance Marketplace

Department of Health and Human Services

465 Industrial Blvd.

London, KY  40750-0061

Or fax it via secure fax to:  1-877-369-0129

The Marketplace Appeals Center will notify the employer in writing that the appeal was received and tell the employer how to correct any errors on the appeal. The Center will then review the appeal and any documentation sent by the employer and/or employee. The Center may request additional information. Appeal decision notices explaining the outcome of the Center’s review will be sent to the employer and employee. If the appeal is successful, the marketplace will notify the employee to update their application and that the employee may be liable for additional tax liabilities.