Appeals

This page describes the appeals process for the Health Connector. To appeal a MassHealth decision, please visit the MassHealth website for more information.

Important: You don’t need to file an appeal to update your information

If you need to update your account information or fix a mistake you made in your application, you do not need to file an appeal. To update your information, take the following steps:

  • Go to the My Eligibility
  • Choose the application you are updating.
  • Under Actions, click on Edit Application.
  • Choose the sections of your application that need to be changed.

Submit your changes on the application Review & Sign page.

Your right to appeal

If you think a decision made by the Massachusetts Health Connector is wrong, you may be able to file an appeal.

If you disagree with the action taken by the Massachusetts Health Connector, you have the right to appeal and ask for a hearing before an impartial hearing officer. You can also request a hearing if no one acted on your request in a reasonable time*.

Decisions you can appeal

You can appeal the following kinds of decisions:

  • Whether you’re eligible to buy a plan through the Health Connector based on your
    • Residency
    • Incarceration status
    • Citizenship/immigration status
  • Whether you can enroll in a plan outside the regular open enrollment period
  • Whether you’re eligible for lower costs or the amount of subsidies you are eligible for based on your
    • Income
    • Family size
    • Access to other insurance
    • Tax-filing status
    • Failure to reconcile a prior year’s Advance Premium Tax Credits
  • Whether you qualify for reduced premiums based on hardship, if you are eligible for ConnectorCare

Your eligibility notice

When you apply for coverage, you’ll get an eligibility notice that explains what you qualify for. It will provide appeals instructions for each person in your household, including the number of days you have to file an appeal.

Tip: If you are unsure if you can appeal a decision, a good way to know is if you get a notice from the Health Connector in the mail and it includes instructions on how to request an appeal, that means you are able to appeal the decision in that notice.

Filing an appeal while you are getting benefits

You may be eligible to keep your benefits while your appeal is decided.

  • If you keep your benefits, and then lose your appeal, you may have to pay back the benefits you received during your appeal.
  • If you do not keep your benefits, and then you win your appeal, we will restore your benefits.
  • Please note that an appeal decision for one household member may result in a change in eligibility for other household members.

Getting help filing an appeal

You can file an appeal yourself, or if you need help Navigators may assist you in filing an appeal and may answer questions about the appeals process. A Navigator is someone who can provide unbiased help when you submit an appeal. He or she may also refer you to another person or organization that can help you. Find a Navigator in your area.

You can also appoint an authorized representative to help you. Your representative can be a family member, friend, advocate, attorney, or someone else who will act for you.

If you have an appeal representative you would like to use, be sure the following information is completed on the appeal form:

  • First name and last name of the representative
  • Their title (or relationship to you, if any)
  • Their mailing address
  • Their phone number

Your right to be helped at the hearing

At the appeal hearing, you may have a lawyer or other person represent you, or you may represent yourself. The Health Connector will not pay for anyone to represent you. You may contact a local legal aid service or community agency to see if you can receive advice or representation at no cost.

If you need an interpreter, assistive device, or other accommodation

If you do not understand English or if you are hearing or sight impaired, we will provide an interpreter or assistive device at the hearing at no cost to you. We will also make other reasonable accommodations a person with a disability may need to participate in the hearing. You can make a note of accommodation you may need when you file an appeal.

How to file an appeal with the Health Connector

To ask for a hearing, fill out the Hearing Request Form that came with your notice and mail it to

Massachusetts Health Connector Appeals Unit
P.O. Box 960189
Boston, MA 02196

Or fax it to

1-617-933-3099

Or, complete an online appeal form by logging into your Account and clicking on “Appeals.”

Tip: For faster processing, be sure to have your Eligibility ID number, found in the “My Account” section when you login to your account. This number is also found on your eligibility notice.

For information about appealing by phone, please call customer service at 1-877-MA-ENROLL (1-877-623-6765).