How We Use Your Information

Study extra about how your particular person Market info is used

This reality sheet supplies extra details about how your info is getting used within the Well being Insurance coverage Market® run by CMS, your rights to entry information which might be maintained about you, your proper to file an attraction, and different useful info. Overview it rigorously.

Click on on the next to study extra about:

What’s the Market?

The Market is a useful resource the place you’ll be able to study your well being protection choices, evaluate medical health insurance plans based mostly on prices, advantages, and different necessary options, select a plan, and enroll in protection. The Market additionally supplies info on packages that assist folks with low to average earnings and sources pay for protection. This contains methods to save lots of on the month-to-month premiums and out-of-pocket prices of protection obtainable by the Market, and details about different packages, 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 Companies (CMS), a part of the U.S. Division of Well being and Human Companies (HHS). In the event you’re making use of for well being protection in a state operating 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 packages, CMS is required to guard the knowledge it collects and maintains. CMS respects your proper to privateness and can defend the knowledge it maintains about you within the ongoing operation of the Market in accordance with all required legal guidelines, rules and requirements. “You” refers to any individual whose info is entered in your utility, or these performing on such an individual’s behalf.

CMS wants your info to find out eligibility for:

  • Enrollment in a Market plan, also referred to as a Certified Well being Plan
  • Insurance coverage affordability packages
  • 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:

  • Allow you to with the applying course of
  • Confirm info like your identification and any earnings historical past you present
  • Provide you with correct details about as many alternative cost-saving packages as potential
  • Allow you to resolve questions in regards to the outcomes of your utility, together with an attraction should you determine to file one
  • Talk with you in the course of the eligibility course of

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

  • Allow you 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
  • Allow you to hold your protection updated
  • Confirm your continued eligibility
  • Carry out ongoing execution of the capabilities of the Market, akin to operation of insurance coverage affordability packages for individuals who are enrolled, and oversight of issuers of Market Well being Plans
  • Reply to any shopper 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 utility to the Market, your info is used to:

  • Pre-populate a Market utility
  • Provide you with correct details about subsequent steps and deadlines
  • Contact you that can assist you transition to the Market
  • Allow you to with the applying 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 might disclose your info to businesses or individuals who want the knowledge for particular causes are supplied under. For extra info, evaluation the System of Data Discover.

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

    • Social Safety might confirm your Social Safety Numbers (SSNs) and citizenship standing.
    • The U.S. Division of Homeland Safety might confirm your immigration standing and/or naturalized citizenship standing.
    • The Inner Income Service (IRS) might confirm your family earnings and household dimension; the earnings of family members may additionally be verified with the Social Safety Administration and with a shopper credit score reporting company
    • A shopper credit score reporting company might confirm your employment info.
    • The employers listed in your utility might 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 Companies, the Workplace of Personnel Administration (OPM), and the Small Enterprise Well being Possibility Applications (SHOP) that function in your state might confirm your eligibility for and/or enrollment in well being protection packages.

    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 would like assist paying for well being protection.

  • Chances are you’ll determine to provide permission to organizations or individuals who can talk with the Market about your utility for such wants as resolving inconsistencies, or making certain full and correct functions. Relying in your permission, they could 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 utility counselor)

    Every utility filer confirms that she or he is permitted to share info for everybody on the applying. That method, the Market has permission to share your info along with your utility filer.

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

    • Notifying employers in your utility should you’re eligible for sure insurance coverage affordability packages (advance cost of the premium tax credit score or cost-sharing reductions).
    • Transferring your enrollment info to the suitable group or company. This is likely to be the issuer of the Market plan that you just chosen, or a Medicaid or CHIP company.
    • Making studies to the Inner Income Service about your enrollment in a professional well being plan by 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 attraction, the knowledge out of your utility and your attraction could also be shared with federal and state businesses listed below #1 above to course of your attraction.

  • When your state Medicaid or Kids’s Well being Insurance coverage Program (CHIP) transfers your well being protection utility to the Market, the Market might 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 utility and enrolling in protection.

  • To keep up Market operation, CMS works with the next teams and should subsequently share your info with:

    • Contractors that carry out capabilities for the Market to perform the precise capabilities they’re engaged to carry out.
    • Different federal, state, or native authorities businesses to fight fraud, waste, and abuse and to answer considerations in regards to the safety or confidentiality of knowledge.
    • Insurance coverage firms that challenge 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 utility?

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

In the event you aren’t exempt from the shared duty cost and don’t preserve qualifying well being protection for 3 months or longer in the course of the yr, chances are you’ll be topic to a penalty.

Make sure you present appropriate info. Anybody who fails to offer appropriate info or who knowingly and willfully supplies 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 folks listed on my utility?

Individuals who apply for well being protection want to offer an SSN if they’ve one. An utility 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 likely be used to confirm the family’s eligibility for assist with paying for well being protection. Different folks not making use of for well being protection are inspired to offer their SSNs to hurry up the applying course of, however aren’t required to offer one. We use SSNs to test earnings and different info to see who’s eligible for assist with well being protection prices. If somebody needs assist getting an SSN, they’ll 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 by 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 turning into a Lawful Everlasting Resident or U.S. citizen. (Exception: Folks receiving long-term care in an establishment at authorities expense, like in a nursing facility, might face limitations getting a inexperienced card).

Immigration info entered into the Market will likely be used for administration of the Market and insurance coverage affordability packages 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 flawed?

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

You possibly can attraction eligibility to purchase Market plans and likewise for enrollment durations. In the event you’re making use of for assist paying for protection, you may additionally have the correct to attraction 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’ll be able to attraction the quantity you’re eligible for.

Overview your eligibility discover to seek out appeals directions for every individual in your family, together with the variety of days it’s important to file an attraction. Right here’s necessary info to think about when submitting an attraction:

  • You possibly can have somebody file or take part in your attraction. That individual generally is a pal, relative, lawyer, or different individual. Or, you’ll be able to file and take part in your attraction by yourself.
  • In the event you file an attraction, you might be able to hold your eligibility for protection whereas your attraction is pending.
  • The end result of an attraction may change the eligibility of different members of your family.
  • Relying in your state and your eligibility outcomes, you might be able to file an attraction by the Market or you will have to file an attraction along with your state Medicaid or CHIP company.
To attraction your Market eligibility outcomes, you’ll be able to mail an attraction type 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 concerning my info within the Market?

  • You, and folks you give permission to, might even see and request a duplicate of the personally identifiable info the Market collects and maintains about you.
  • Chances are you’ll query if the knowledge CMS has about you is appropriate.
  • You’ve got the correct to ask for an accounting of the entities or folks to whom the Market has disclosed your info.
  • In the event you don’t perceive the knowledge on this web page, chances are you’ll contact the Market for a proof, and you may ask the Market for a duplicate of this discover.