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If you don’t agree with a decision made by the Health Insurance Marketplace, you may be able to file an appeal.

Decisions you can appeal
You can appeal the following kinds of Marketplace decisions:

Whether you’re eligible to buy a Marketplace plan
Whether you can enroll in a Marketplace plan outside the regular open enrollment period
Whether you’re eligible for lower costs based on your income
The amount of savings you’re eligible for
Whether you’re eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
Whether you are eligible for an exemption from the individual responsibility requirement
Your eligibility notice
When you apply for coverage in the Marketplace, 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.

Here’s important information to consider when planning an appeal:

You can have someone else file or participate in your appeal. That person can be a friend, relative, lawyer, or other person. Or you can handle the appeal yourself.
If you file an appeal, you may be able to keep your eligibility for coverage while your appeal is pending. You’ll get a letter that describes your options.
The outcome of an appeal could change the eligibility of other members of your household.
Depending on your state and your eligibility results, you may be able to appeal through the Marketplace. Or you may have to file an appeal with your state Medicaid or CHIP agency. Your letter will explain.

4 ways to file Marketplace appeals
Your eligibility determination letter will explain how to file an appeal. In general, you can appeal your eligibility results 4 ways:

Log into your “My Account” at HealthCare.gov/marketplace/individual (find the icon at the top right of the screen)
Call 1-800-318-2596 or (TTY: 1-855-889-4325)
Write a letter to:
Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061
Mail in an appeal request form, using the proper form below:
Appeal Request Form for the following 10 states:

Alabama

Arkansas

Idaho

Louisiana

Montana

New Jersey

Tennessee

Texas

West Virginia

Wisconsin

Appeal Request Form for the following 2 states:

Wyoming

Pennsylvania

Appeal Request Form for all other states

After you file an appeal
You’ll get a letter that:

States that your appeal request was received
Provides a description of the appeals process
Includes instructions for submitting additional material for consideration, if necessary
While your appeal is being processed
You may get a letter from us asking for more information or documentation, like a copy of a passport. If you send this information to us, we may be able to informally resolve your case fairly quickly.

In general, we must tell you our decision and mail our response within 90 days of when we received your appeal request.

Getting help filing an appeal
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.

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.

How to appoint a representative to handle your appeal

You can appoint a representative either of 2 ways:

Complete an “Appointment of Representative” form. These forms will be available soon.
Submit a written request with your appeal. Be sure to include:

Your name, address, and phone number
Your (case/record/request/file) number
A statement appointing someone as your representative
The name, address, and phone number of your representative
The professional status of your representative or their relationship to you
A statement authorizing the release of your personal and identifiable information to your representative
A statement explaining why you’re being represented
Your representative’s signature and the date they signed the request
Getting help in a language other than English
You have the right to get help and information about appeals and other Marketplace issues in your language at no cost. To talk to an interpreter, call 1-800-318-2596.

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Preventive Health Services
Q8: Some of the recommendations and guidelines of the United States Preventive Services Task Force (USPTF), the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (Advisory Committee) and the Health Resources and Services Administration (HRSA) do not definitively state the scope, setting, or frequency of the items or services to be covered. What should my plan do if an individual requests, for example, daily counseling for diet?
The interim final regulations regarding preventive health services provide that if a recommendation or guideline for a recommended preventive health service does not specify the frequency, method, treatment, or setting for the provision of that service, the plan or issuer can use reasonable medical management techniques (which generally limit or exclude benefits based on medical necessity or medical appropriateness using prior authorization requirements, concurrent review, or similar practices) to determine any coverage limitations under the plan. Thus, to the extent not specified in a recommendation or guideline, a plan or issuer may rely on the relevant evidence base and these established techniques to determine the frequency, method, treatment, or setting for the provision of a recommended preventive health service.

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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) amended ERISA, the Code, and the PHS Act to add, among other things, provisions prohibiting discrimination in eligibility, benefits, or premiums based on a health factor. An exception to the general rule is provided for certain wellness programs that discriminate in benefits and/or premiums based on a health factor. In 2006, the Departments published final regulations implementing these nondiscrimination and wellness provisions (HIPAA nondiscrimination regulations).(5)
The final regulations generally divide wellness programs into two categories. First, programs that do not require an individual to meet a standard related to a health factor in order to obtain a reward are not considered to discriminate under the HIPAA nondiscrimination regulations and therefore, are permissible without conditions under such rules (“participatory wellness programs”). Examples in the regulations include a fitness center reimbursement program, a diagnostic testing program that does not base rewards on test outcomes, a program that waives cost-sharing for prenatal or well-baby visits, a program that reimburses employees for the cost of smoking cessation aids regardless of whether the employee quits smoking, and a program that provides rewards for attending health education seminars.
The second category of wellness programs under the final rules consists of programs that require individuals to satisfy a standard related to a health factor in order to obtain a reward (“health-contingent wellness programs”). Examples include a program that requires an individual to obtain or maintain a certain health outcome in order to obtain a reward (such as being a non-smoker, attaining certain results on biometric screenings, or exercising a certain amount). Although such a premium or benefit reward may discriminate based on a health factor, an exception outlined in paragraph (f)(2) of the final rules permits such programs if the program provides the following safeguards:
The total reward for such wellness programs offered by a plan sponsor is limited to 20 percent of the total cost of employee-only coverage under the plan. (However, if any class of dependents can participate in the program, the limit on the reward is modified so that the 20 percent is calculated with respect to the total cost of coverage in which the employee and any dependents are enrolled.)
The program must be reasonably designed to promote health or prevent disease. For this purpose, it must: have a reasonable chance of improving health or preventing disease, not be overly burdensome, not be a subterfuge for discriminating based on a health factor, and not be highly suspect in method.
The program must give eligible individuals an opportunity to qualify for the reward at least once per year.
The reward must be available to all similarly situated individuals. For this purpose, a reasonable alternative standard (or waiver of the original standard) must be made available to individuals for whom it is unreasonably difficult due to a medical condition to satisfy the original standard during that period (or for whom a health factor makes it unreasonably difficult or medically inadvisable to try to satisfy the original standard).
In all plan materials describing the terms of the program, the availability of a reasonable alternative standard (or waiver of the original standard) is disclosed.
The Affordable Care Act added a new section 2705 to the PHS Act regarding nondiscrimination and wellness. Section 715(a)(1) of ERISA and section 9815(a)(1) of the Code incorporate section 2705 of the PHS Act by reference. PHS Act section 2705 largely incorporates the provisions of the Departments’ joint final regulations with a few clarifications and changes the maximum reward that can be provided under a health-contingent wellness program from 20 percent to 30 percent. This change is effective in 2014.
The Departments intend to propose regulations that use existing regulatory authority under HIPAA to raise the percentage for the maximum reward that can be provided under a health-contingent wellness program to 30 percent before the year 2014. The Departments are also considering what accompanying consumer protections may be needed to prevent the program from being used as a subterfuge for discrimination based on health status. Additionally, the following FAQs provide answers to frequently-asked questions regarding wellness programs.

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Q15: My group health plan offers two different wellness programs, both of which are offered to all full-time employees enrolled in the plan. The first program requires participants to take a cholesterol test and provides a 20 percent premium discount for every individual with cholesterol counts under 200. The second program reimburses participants for the cost of a monthly membership to a fitness center. If I participate in both wellness programs and receive both rewards (the 20 percent premium discount and the reimbursement for the cost of a fitness center membership), is my plan violating the HIPAA nondiscrimination regulations?
No. In this scenario, the first program is subject to the requirements of the HIPAA nondiscrimination regulations because the premium discount reward is based on an individual satisfying a standard that is related to a health factor (having a cholesterol count under 200). Therefore, the first program must meet the five criteria in the regulations, including the 20 percent limit on the amount of the reward. The second program is not based on an individual satisfying a standard that is related to a health factor, so it does not have to satisfy the five criteria in the regulations.
Furthermore, it is permissible to offer both programs at the same time because the rule limiting the amount of the reward for health-contingent wellness programs to 20 percent of the cost of coverage only applies to programs that require satisfaction of a standard related to a health factor.
As previously noted, the Departments intend to propose regulations that use existing regulatory authority under HIPAA to raise the percentage for the maximum reward that can be provided under a health-contingent wellness program to 30 percent before the year 2014 and are also considering what accompanying consumer protections may be needed to prevent the program from being used as a subterfuge for discrimination based on health status. More guidance is expected early next year.
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On August 1, 2011,
HRSA adopted and released guidelines for women's preventive health
services (HRSA Guidelines) based on recommendations of the independent
Institute of Medicine. As relevant here, the HRSA Guidelines include
all Food and Drug Administration (FDA)-approved contraceptive methods,
sterilization procedures, and patient education and counseling for
women with reproductive capacity, as prescribed by a health care
provider (collectively, contraceptive services).\1\ Except as discussed
later in this section, non-grandfathered group health plans and health
insurance coverage are required to provide coverage consistent with the
HRSA Guidelines without cost sharing for plan years (in the individual
market, policy years) beginning on or after August 1, 2012.\2\
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    \1\ The HRSA Guidelines exclude services relating to a man's
reproductive capacity, such as vasectomies and condoms.
    \2\ Interim final regulations published by the Departments on
July 19, 2010, generally provide that plans and issuers must cover a
newly recommended preventive service starting with the first plan
year (in the individual market, policy year) that begins on or after
the date that is one year after the date on which the new
recommendation is issued. 26 CFR 54.9815-2713T(b)(1); 29 CFR
2590.715-2713(b)(1); 45 CFR 147.130(b)(1).

Quoted from Shadow

Let the rationing begin.

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In addition, the Regulatory Flexibility Act (RFA) may require the
preparation of an analysis of the impact on small entities of proposed
rules and regulatory alternatives. An analysis under the Regulatory
Flexibility Act must generally include, among other things, an estimate
of the number of small entities subject to the regulations (for this
purpose, plans, employers, and issuers and, in some contexts small
governmental entities), the expense of the reporting, recordkeeping,
and other compliance requirements (including the expense of using
professional expertise), and a description of any significant
regulatory alternatives considered that would accomplish the stated
objectives of the statute and minimize the impact on small entities.
For this purpose, the Departments consider a small entity to be an
employee benefit plan with fewer than 100 participants.
    The Paperwork Reduction Act (PRA) requires an estimate of how many
respondents will be required to comply with any ``collection of
information'' requirements contained in regulations and how much time
and cost will be incurred as a result. A collection of information
includes recordkeeping, reporting to governmental agencies, and third-
party disclosures.
    The Departments are requesting comments that may contribute to the
analyses that will be performed under these requirements, both
generally and with respect to the following specific areas:
    1. What costs and benefits are associated with expanded use of VBID
methods? How do costs and benefits vary among different types of
preventive screenings, lifestyle interventions, medications,
immunizations, and diagnostic tests?
    2. What policies, procedures, practices and disclosures of group

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health plans and health insurance issuers would be impacted by expanded
use of VBID methods? What direct or indirect costs and benefits would
result? Which stakeholders will be impacted by such benefits and costs?

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The Affordable Care Act includes provisions intended to encourage workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health, and slow the growth of health care costs. One provision of the Public Health Service Act (Section 2705(m)(1)), as amended by the Affordable Care Act, directs that the Secretary of the Department of Health and Human Services (HHS), in consultation with the Secretaries of the Treasury and Labor, gather relevant information from employers who provide employees with access to wellness programs, including state and federal agencies, and submit a report to the appropriate committees of Congress concerning:
(1)    the effectiveness of wellness programs;
(2)     the impact of such wellness programs on the access to care and affordability of coverage for participants and non-participants of such programs;  
(3)    the impact of premium-based and cost-sharing incentives on participant behavior and the role of such programs in changing behavior; and
(4)    the effectiveness of different types of rewards.

At the request of HHS, the Department of Labor (DOL) contracted with the RAND Corporation to help to prepare this report to fulfill this provision of the Affordable Care Act. This study consists of four parts: a) a literature review, b) a national representative employer survey, c) analysis of an existing industry-wide database (Care Continuum Alliance or CCA database) to which wellness providers contribute data anonymously, and d) five case studies. The Workplace Wellness Programs Study Final Report is attached.

A wellness program is defined in section 2705(j)(1)(A) of the Public Health Service Act, as amended by the Affordable Care Act, as a program offered by an employer designed to promote health or prevent disease.  Certain types of wellness programs offered through employment-based group health plan coverage must meet standards the Affordable Care Act sets forth.  More broadly, there is a wide array of workplace wellness programs which include employment-based activities or employer-sponsored benefits aimed to promote health-related behaviors (primary prevention or health promotion) and disease management (secondary prevention). Wellness programs may include a combination of data collection on employee health risks with population-based strategies and individually-focused interventions to reduce those risks. Programs may be part of a group health plan or offered outside of that context. They may range from narrow offerings, such as free gym memberships, to comprehensive counseling and lifestyle management interventions.

The burden of chronic disease is growing in the United States as rising rates of obesity and physical inactivity are leading to more diabetes and cardiovascular disease. Particularly worrisome is that the onset of chronic conditions such as obesity and hypertension is shifting to younger age cohorts, who are still participating in the labor market. This shift increases the economic burden of chronic disease, as illness-related loss of productivity is added to the cost of medical care. To counter this trend, employers are adopting health promotion and disease prevention strategies, taking advantage of their access to employees at an age where interventions directed at healthy behaviors can still change the trajectory of employees’ long-term health. These strategies range from changes to the working environment, such as providing healthy food options in the cafeteria, to comprehensive interventions that support employees in adopting and sustaining healthy lifestyles.

Quoted from Box A Rox

No Shadow... Rationing in the USA has been the norm for decades.  
Harvard Medical School researchers released a study concluding that 45,000 Americans die
every year because they lack health insurance and access to health care.

"In this country, we mainly ration on the ability to pay." In fact, because the supply of doctors,
hospitals, and treatments is never unlimited, medical care is rationed in every country, whether
by the government, the private market, or some combination of the two.

Rationing by price, or ability to pay, is familiar to most Americans. Often, this way of allocating
health care means that poor and low-income people cannot get care at all, but it also means
that they might get different kinds of care in a system that treats people differently on the basis
of whether and how much they can pay.

Scientific American (Health Care Rationing Is Nothing New)
http://www.scientificamerican.com/article.cfm?id=health-care-rationing-is

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Effectiveness of wellness programs
A review of the scientific literature evaluating the impact of workplace wellness programs on health-related behavior and medical cost outcomes found, consistent with previous reviews, evidence for positive effects on diet, exercise, smoking, alcohol use, physiologic markers and healthcare costs, but limited evidence for effects on absenteeism and mental health. It was not clear from the literature whether program intensity was positively correlated with impact. Positive results found in the literature review studies should be interpreted with caution as many of these programs were not evaluated with a rigorous approach, and published results tend to focus on larger employers and therefore may not be representative of the experience of a typical U.S. employer. A RAND analysis of the CCA database, when comparing wellness program participants to statistically matched non-participants, found statistically significant and clinically meaningful improvements in exercise frequency, smoking behavior, and weight control, but not in cholesterol control.