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How does the Individual Marketplace Determine Eligibility?

The following phases illustrate the process of how the Individual Marketplace determines eligibility.


  • Application: Upon request, agents and brokers are expected to assist consumers in submitting applications.

  • Eligibility Determination: Application filers may request an eligibility determination for enrollment in a Qualified Health Plan and for insurance affordability programs.

  • Verification: The Marketplace verifies applicants’ information using data from key federal agencies and other sources.

  • Notification: The Marketplace provides applicants timely written notice of their eligibility determinations.


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