What could happen if the Marketplace Appeals Center finds that a consumer's eligibility determination was incorrect?

If the Marketplace Appeals Center finds that a consumer’s eligibility determination was incorrect, there are several potential outcomes concerning the consumer’s health insurance coverage and related financial implications.

When a determination is deemed incorrect, it may lead to a situation where the consumer's eligibility for financial assistance or coverage needs to be recalibrated. This can involve the consumer owing money to their Marketplace plan if they were originally granted financial assistance that they were not eligible for, thus creating a liability for the premiums they received.

Additionally, if the determination was incorrect to the point that the consumer was entitled to different coverage or assistance than they received, they may also be eligible for a refund of premiums paid during the period in question. This could occur if it’s found that they were eligible for a higher level of assistance or certain benefits that were not initially applied.

Therefore, both aspects B and C are valid outcomes of the appeals process, making the combined answer the most comprehensive conclusion in relation to the potential consequences for the consumer.