Find official help for health coverage questions
Match enrollment, appeals, billing, and consumer-protection questions to the agency or resource that can address them.
# Find official help for health coverage questions
Start with the organization that administers the issue. Keep your plan name, member ID, dates, notices, bills, and call reference numbers together. Never send sensitive information through an unverified link or to a number from an unsolicited message.
Enrollment and eligibility
For a Marketplace application, premium tax credits, plan comparisons, and Special Enrollment Period questions, use HealthCare.gov or the official Marketplace for your state. Its local help directory can locate navigators and certified assisters. For Medicaid and CHIP eligibility, follow the official state agency link provided by HealthCare.gov or your state government.
For employer coverage, contact the benefits administrator or plan administrator shown in the plan documents. For COBRA election and continuation questions, the U.S. Department of Labor EBSA provides assistance for private-sector employer plans. Public-sector plans may have different administrators.
Claims, denials, and network bills
For a claim status or a provider-directory question, call the insurer using the member card. For a denial, use the appeal instructions and deadline in the written notice; ask whether expedited review is available when care is urgent. CMS explains internal appeals and external review.
For a possible No Surprises Act issue, review CMS Medical Bill Rights and its help resources. These protections cover specified situations, not every out-of-network service. Keep the itemized bill, explanation of benefits, and any notice-and-consent forms.
State-specific support
Insurance regulation often depends on the state and plan type. Find the official state insurance department through the National Association of Insurance Commissioners directory. The department may help with regulated insurance complaints; it may not regulate a self-funded employer plan. Ask EBSA or the plan administrator who has jurisdiction if uncertain.
Prepare before contacting help
Write a short timeline, state the action you want, and have the relevant notice or bill in front of you. Ask for the case number, the next deadline, and where to submit records. Request important explanations in writing. This directory points to starting places, not a guarantee that an agency can decide an individual claim.
