public-service · marketplace renewal notice deadline
Marketplace Renewal: What Happens After 30 Days
45 CFR 155.335 directs the Exchange to the paragraph (h)(1) procedures when a renewal notice is not signed and returned within the stated 30-day period.
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Updated: Sources: 1
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What matters now
- 45 CFR § 155.335 requires a default redetermination using the notice's own projected figures.
- The quoted redetermination provision uses the notice information as supplemented by information reported by the individual and verified by the Exchange.
- The annual notice itself must already state next year's projected subsidy and coverage-level figures.
If a Marketplace enrollee does not sign and return an annual renewal notice within the 30-day period referenced in 45 CFR 155.335, the regulation directs the Exchange to proceed under paragraph (h)(1). That paragraph describes a redetermination using information in the notice as supplemented by information reported by the individual and verified by the Exchange.
This original record-reading guide is a general reading aid, not cited evidence. It does not depict a source record; the article text and source links provide the facts.
Key points
- The annual renewal notice must state the enrollee’s projected eligibility determination for the following year, including any advance premium tax credit amount and cost-sharing reduction level, “after considering any updated information described in paragraph (b) of this section” (ecfr.gov).
- There is a defined 30-day window for the enrollee to sign and return that notice.
- Non-response within the 30-day period is not left open-ended: the regulation “must proceed in accordance with the procedures specified in paragraph (h)(1) of this section” (ecfr.gov).
- The quoted paragraph (h)(1) describes a redetermination using notice information as supplemented by information reported by the individual and verified by the Exchange.
What the renewal notice must say
The regulation requires the Exchange’s annual notice to include a specific, forward-looking eligibility determination, not a generic reminder. It must state:
“The qualified individual’s projected eligibility determination for the following year, after considering any updated information described in paragraph (b) of this section, including, if applicable, the amount of any advance payments of the premium tax credit and the level of any cost-sharing reductions or eligibility for Medicaid, CHIP or BHP.” (https://www.ecfr.gov/current/title-45/section-155.335)
This is the figure and coverage-level projection the enrollee is being asked to confirm or update when they sign and return the notice.
Thirty-day response window
The regulation sets a fixed period for a response and defines exactly what happens if that period lapses without one:
“To the extent that a qualified individual does not sign and return the notice described in paragraph (c) of this section within the 30-day period specified in paragraph (e) of this section, the Exchange must proceed in accordance with the procedures specified in paragraph (h)(1) of this section.” (https://www.ecfr.gov/current/title-45/section-155.335)
The cross-referenced procedure is specified in paragraph (h)(1), quoted below.
What the default redetermination uses
The regulation ties the default redetermination to two specific information sources — nothing broader:
“Redetermine the qualified individual’s eligibility in accordance with the standards specified in § 155.305 using the information provided to the qualified individual in the notice specified in paragraph (c) of this section, as supplemented with any information reported by the qualified individual and verified by the Exchange in accordance with paragraphs (e) and (f) of this section.” (https://www.ecfr.gov/current/title-45/section-155.335)
The quoted provision identifies the notice information and the information reported by the individual and verified by the Exchange as inputs to the redetermination.
What this article does not answer
This article covers only the federal default-redetermination rule in 45 CFR § 155.335 for non-response to the annual renewal notice. It does not state what any individual reader’s own projected eligibility determination for next year will be, and it does not state what any individual’s actual advance premium tax credit amount or cost-sharing reduction level will turn out to be — those depend on each household’s own reported and verified information. It does not address whether a specific reader’s current plan will still exist or be offered next year. And it does not describe any state-based Exchange’s own notice format, mailing or electronic delivery timing, or address-of-record procedures; those operational details sit outside the federal regulation text quoted here and vary by Exchange.