How We Use Your Knowledge

Study extra about how your particular person Market info is used

This truth sheet gives extra details about how your info is getting used within the Well being Insurance coverage Market® run by CMS, your rights to entry data which can be maintained about you, your proper to file an enchantment, and different useful info. Assessment it rigorously.

Click on on the next to study extra about:

What’s the Market?

The Market is a useful resource the place you possibly can study your well being protection choices, evaluate medical insurance plans based mostly on prices, advantages, and different essential options, select a plan, and enroll in protection. The Market additionally gives info on applications that assist individuals with low to average earnings and assets pay for protection. This consists of methods to save lots of on the month-to-month premiums and out-of-pocket prices of protection obtainable via the Market, and details about different applications, together with Medicaid and the Kids’s Well being Insurance coverage Program (CHIP). In some states, the Market is run by the state. In others it’s run by the Facilities for Medicare & Medicaid Providers (CMS), a part of the U.S. Division of Well being and Human Providers (HHS). In the event you’re making use of for well being protection in a state working its personal Market, go to and also you’ll be directed to your state’s market. This web page describes how the Marketplaces run by CMS use your info, and doesn’t apply to Marketplaces run by states.

How does the Market use my info?

As a federal company working the Market and related applications, CMS is required to guard the data it collects and maintains. CMS respects your proper to privateness and can defend the data it maintains about you within the ongoing operation of the Market in accordance with all required legal guidelines, laws and requirements. “You” refers to any individual whose info is entered in your software, or these appearing on such an individual’s behalf.

CMS wants your info to find out eligibility for:

  • Enrollment in a Market plan, often known as a Certified Well being Plan
  • Insurance coverage affordability applications
  • Certifications of exemption from the person duty requirement

Whenever you apply for well being protection or an exemption, your info could also be used to:

  • Provide help to with the appliance course of
  • Confirm info like your identification and any earnings historical past you present
  • Offer you correct details about as many various cost-saving applications as doable
  • Provide help to resolve questions in regards to the outcomes of your software, together with an enchantment should you determine to file one
  • Talk with you through the eligibility course of

Whenever you enroll in well being protection, your info could also be used to:

  • Provide help to enroll
  • Report and handle the advance funds of premium tax credit score and cost-sharing reductions to the issuer of your Market plan, should you’re eligible
  • Talk with you all through the enrollment course of

After you enroll in well being protection, your info could also be used to:

  • Proceed communications with you
  • Provide help to hold your protection updated
  • Confirm your continued eligibility
  • Carry out ongoing execution of the features of the Market, comparable to operation of insurance coverage affordability applications for individuals who are enrolled, and oversight of issuers of Market Well being Plans
  • Reply to any client suggestions or complaints you file
  • Fight fraud and abuse within the federal well being care system
  • Reply to suspected or confirmed breaches of Market safety or confidentiality of knowledge

When your state Medicaid or Kids’s Well being Insurance coverage Program (CHIP) transfers a well being protection software to the Market, your info is used to:

  • Pre-populate a Market software
  • Offer you correct details about subsequent steps and deadlines
  • Contact you that will help you transition to the Market
  • Provide help to with the appliance and enrollment course of

Who can my Market info be shared with and why?

CMS will solely share your info as wanted and described within the System of Data Discover or as approved or required by regulation. Examples of when CMS could disclose your info to companies or individuals who want the data for particular causes are supplied under. For extra info, evaluation the System of Data Discover.

  • Whenever you apply, CMS verifies the data you present with these organizations and companies to find out your eligibility to buy a professional well being plan via the Market and, should you select, for assist paying for well being protection:

    • Social Safety could confirm your Social Safety Numbers (SSNs) and citizenship standing.
    • The U.S. Division of Homeland Safety could confirm your immigration standing and/or naturalized citizenship standing.
    • The Inner Income Service (IRS) could confirm your family earnings and household measurement; the earnings of family members may be verified with the Social Safety Administration and with a client credit score reporting company
    • A client credit score reporting company could confirm your employment info.
    • The employers listed in your software could confirm your eligibility for employer-sponsored well being plans.
    • The State Medical Help (Medicaid) workplace, the Kids’s Well being Insurance coverage Program (CHIP), the U.S. Division of Veterans Affairs, Medicare, Peace Corps, U.S. Division of Protection (for TRICARE), U.S. Division of Well being and Human Providers, the Workplace of Personnel Administration (OPM), and the Small Enterprise Well being Possibility Packages (SHOP) that function in your state could confirm your eligibility for and/or enrollment in well being protection applications.

    Not all candidates might want to present all of this info. For instance, you’ll be requested about your employment, earnings, and enrollment in well being protection solely if you’d like assist paying for well being protection.

  • You might determine to provide permission to organizations or individuals who can talk with the Market about your software for such wants as resolving inconsistencies, or making certain full and correct functions. Relying in your permission, they might embody:

    • Your approved representatives
    • Your chosen Market-certified agent or dealer, or the insurance coverage firm that points your Market well being plan
    • Your chosen Market-certified assister (Navigator grantee, enrollment help contractor, or licensed software counselor)

    Every software filer confirms that she or he is permitted to share info for everybody on the appliance. That manner, the Market has permission to share your info together with your software filer.

  • As soon as you choose protection, CMS will use your info for functions comparable to:

    • Notifying employers in your software should you’re eligible for sure insurance coverage affordability applications (advance cost of the premium tax credit score or cost-sharing reductions).
    • Transferring your enrollment info to the suitable group or company. This is perhaps the issuer of the Market plan that you simply chosen, or a Medicaid or CHIP company.
    • Making reviews to the Inner Income Service about your enrollment in a professional well being plan via the Market and about your eligibility for advance cost of the premium tax credit score, cost-sharing reductions, and/or a certification of exemption from the person duty requirement(s)
  • In the event you select to submit an enchantment, the data out of your software and your enchantment could also be shared with federal and state companies listed beneath #1 above to course of your enchantment.

  • When your state Medicaid or Kids’s Well being Insurance coverage Program (CHIP) transfers your well being protection software to the Market, the Market could share your info with enrollment help contractors or Market-certified grantees engaged on behalf of the Market to conduct outreach to supply assist to you with subsequent steps in finishing your Market software and enrolling in protection.

  • To take care of Market operation, CMS works with the next teams and should due to this fact share your info with:

    • Contractors that carry out features for the Market to perform the particular features they’re engaged to carry out.
    • Different federal, state, or native authorities companies to fight fraud, waste, and abuse and to reply to issues in regards to the safety or confidentiality of knowledge.
    • Insurance coverage firms that difficulty Market plans and likewise the IRS, for the continuing administration of advance cost of premium tax credit and cost-sharing reductions, if relevant to you.
    • Issuers of certified well being plans and states, should you complain to us a couple of certified well being plan or an issuer, to inform the issuers and state in regards to the complaints.

Do I’ve to reply the questions on my Market software?

You don’t have to provide personally identifiable info (PII), together with Social Safety Numbers. Nonetheless, should you don’t give this info, it might delay or forestall the Market from performing all features, like telling you about getting assist paying for protection, or figuring out your eligibility for advantages, applications or exemptions.

In the event you aren’t exempt from the shared duty cost and don’t keep qualifying well being protection for 3 months or longer through the yr, you could be topic to a penalty.

Make sure you present right info. Anybody who fails to offer right info or who knowingly and willfully gives false or unfaithful info to the Market could also be topic to a penalty and different regulation enforcement motion.

Do I’ve to offer Social Safety Numbers (SSNs) for individuals listed on my software?

Individuals who apply for well being protection want to offer an SSN if they’ve one. An software filer should additionally present the SSN of any tax filer who isn’t making use of for well being protection if the tax filer’s tax info will probably be used to confirm the family’s eligibility for assist with paying for well being protection. Different individuals not making use of for well being protection are inspired to offer their SSNs to hurry up the appliance course of, however aren’t required to offer one. We use SSNs to examine earnings and different info to see who’s eligible for assist with well being protection prices. If somebody desires assist getting an SSN, they will go to, or name 1-800-772-1213. TTY customers ought to name 1-800-325-0778.

Can individuals who aren’t U.S. residents apply for well being protection via the Market?

Lawfully current immigrants can apply for well being protection. Making use of or enrolling doesn’t make somebody a “public charge”. This implies it gained’t have an effect on their probabilities of changing into a Lawful Everlasting Resident or U.S. citizen. (Exception: Individuals receiving long-term care in an establishment at authorities expense, like in a nursing facility, could face obstacles getting a inexperienced card).

Immigration info entered into the Market will probably be used for administration of the Market and insurance coverage affordability applications solely. Individuals who aren’t making use of for well being protection don’t want to offer their citizenship or immigration standing.

What ought to I do if I feel my eligibility outcomes are incorrect?

In the event you don’t agree with what you qualify for, in lots of instances you might be able to file an enchantment.

You may enchantment eligibility to purchase Market plans and likewise for enrollment intervals. In the event you’re making use of for assist paying for protection, you might also have the precise to enchantment eligibility for tax credit, cost-sharing reductions, Medicaid eligibility, and CHIP eligibility. In the event you qualify for tax credit or cost-sharing reductions, you possibly can enchantment the quantity you’re eligible for.

Assessment your eligibility discover to search out appeals directions for every individual in your family, together with the variety of days it’s important to file an enchantment. Right here’s essential info to contemplate when submitting an enchantment:

  • You may have somebody file or take part in your enchantment. That individual generally is a good friend, relative, lawyer, or different individual. Or, you possibly can file and take part in your enchantment by yourself.
  • In the event you file an enchantment, you might be able to hold your eligibility for protection whereas your enchantment is pending.
  • The end result of an enchantment might change the eligibility of different members of your family.
  • Relying in your state and your eligibility outcomes, you might be able to file an enchantment via the Market or you will have to file an enchantment together with your state Medicaid or CHIP company.
To enchantment your Market eligibility outcomes, you possibly can mail an enchantment kind or your individual letter to Well being Insurance coverage Market, 465 Industrial Blvd, London, KY 40750-0061. For extra info name the Market Name Heart at 1-800-318-2596. TTY customers ought to name 1-855-889-4325.

What are my rights relating to my info within the Market?

  • You, and other people you give permission to, might even see and request a replica of the personally identifiable info the Market collects and maintains about you.
  • You might query if the data CMS has about you is right.
  • You could have the precise to ask for an accounting of the entities or individuals to whom the Market has disclosed your info.
  • In the event you don’t perceive the data on this web page, you could contact the Market for an evidence, and you’ll ask the Market for a replica of this discover.