Layers
Download
Sample letter: Dana Reyes expects $41,200 in 2027 and sends her last two pay stubs. Sample letter: Dana Reyes expects $41,200 in 2027 and sends her last two pay stubs.

Ready, not blank.

Download the letter in Word

The letter is written. Add your income, what changed and what you attach.

Then. Upload it in your Marketplace account with your documents and keep a copy.

Marketplace data matching issue: proof of income — your letter is ready

If your Marketplace letter asks you to confirm income, you generally have 90 days, and the exact due date is in that letter. Send documents that show a yearly income close to the amount on your application. Use the letter below to say what changed and list what you are sending.

Updated: · Next check: 2027-02-06

Marketplace data matching issue: proof of income Opening…
Marketplace data matching issue: proof of income: first page
Download Word Save + deadline reminder

We use your email only to send the file and the reminders you ask for. Unsubscribe in one click.

Send:

We will ask you to confirm this address, then email you the recipient’s reply.

Open full screen

Start typing right in the document — no sign-up. It stays in this browser; save it to your free Layers account to keep it, open it on your phone and share it.

Embed on your site

Paste this code on your site (law office, school, blog) — readers fill in the template right on your page, free.

Lida, Layers template assistant

Lida, Layers template assistant

Send the document closest to this year's income, not the easiest one to find.

Write the application ID on everything you send.

Full text of the letter

Replace what is in square brackets. It is the same text as the Word file.

Download Word (.docx) Free, no sign-up · CC BY 4.0 license

Letter of Explanation: Household Income

[FULL NAME]
[ADDRESS]
[PHONE] · [EMAIL]

[DATE]

Health Insurance Marketplace
Attn: Coverage Processing
465 Industrial Blvd.
London, KY 40750

Re: Income for [YEAR] · Application ID [APPLICATION ID]

To the Marketplace:

I received your letter dated [DATE OF YOUR LETTER] asking me to confirm my household income.

My household expects to get $[ANNUAL INCOME] in [YEAR].

This amount differs from your records because [WHAT CHANGED, FOR EXAMPLE: I CHANGED JOBS ON A DATE, MY HOURS WERE CUT, MY BUSINESS EARNED LESS].

Household memberEmployer or businessExpected in [YEAR]
[NAME][EMPLOYER OR BUSINESS]$[AMOUNT]
[NAME][EMPLOYER OR BUSINESS]$[AMOUNT]
Total$[ANNUAL INCOME]

I am sending these documents with this letter:

  • [DOCUMENT, FOR EXAMPLE: MY LAST TWO PAY STUBS]
  • [DOCUMENT, FOR EXAMPLE: SELF-EMPLOYMENT LEDGER FROM JANUARY 1 TO OCTOBER 31]

This information is true to the best of my knowledge.

[SIGNATURE]

[FULL NAME]

Deadlines

The rules, with the source

WhatDeadlineSource
Time to respond90 days to confirm information that does not match. Your letter shows the exact due dateHealthCare.gov, Documents and deadlines
What your documents must showA yearly income that closely matches the amount on your applicationHealthCare.gov, data matching issues
Documents on the listTax return (1040), W-2 or 1099, pay stub, self-employment documents, Social Security statement, unemployment benefits letterHealthCare.gov, data matching issues
New job this yearSend recent pay stubs from the new job, not last year's return or W-2HealthCare.gov, data matching issues
Self-employment ledgerThere is no standard format. Show your name, company, income, the dates covered and net income from profit or lossHealthCare.gov, data matching issues; self-employed income
No documents at allUse the official Annual Income Letter of Explanation formHealthCare.gov form
How to uploadLog in, select your current application, then Application details, then Upload documentsHealthCare.gov, Documents and deadlines
How to mailSend a copy, not the original, with the bar code page from your letter. Without it, put your name and application ID on each pageHealthCare.gov form
After you sendA notice usually comes about a month after the Marketplace receives your documentsCMS training module
If the due date has passedSend your documents anyway. You may lose coverage or savings, and the Marketplace re-checks you with what it already hasHealthCare.gov, Documents and deadlines
Open Enrollment for 2027 on HealthCare.govNovember 1, 2026 to January 15, 2027. Enroll by December 15 for coverage from January 1HealthCare.gov; CMS fact sheet, October 30, 2026

These are HealthCare.gov rules. If your state runs its own Marketplace, follow its letter and website.

Step by step

What to do, in order

  1. 1

    Find your letter

    Note the due date, the application ID and what it asks you to confirm.

  2. 2

    Add up your income

    Use the combined yearly income for your household.

  3. 3

    Choose your documents

    Pick the ones closest to this year's income.

  4. 4

    Fill in the letter

    Say what changed and list what you attach.

  5. 5

    Upload it

    Upload is faster than mail. Keep a copy.

  6. 6

    Watch for the notice

    It says the matter is settled or what else is needed.

Questions

What is a data matching issue?

It means something on your application does not match the Marketplace's trusted data sources. You confirm it by sending documents.

What documents prove my income?

A 1040, W-2 or 1099, pay stub, self-employment documents, a Social Security statement or an unemployment benefits letter. Each must show your name and the income amount. You may need more than one.

How do I prove self-employment income?

Use a Schedule C, your latest profit and loss statement or a self-employment ledger. A ledger has no standard format, so a spreadsheet works. Show the dates covered and your net income.

What if I have no documents at all?

Use the official Annual Income Letter of Explanation from HealthCare.gov. When you upload it, choose Letter of explanation as the document type.

What if I need more time?

If you tried in good faith, call the Marketplace at 1-800-318-2596 and ask for more time.

Official sources

Other documents

All templates: United States →

Keep the papers in one place

Letters, receipts and notices in one folder you can share with family or a lawyer. The templates and the editor are free; Layers is free for up to 20 people.

Start free Get the Word file

This is general information and a letter template, not legal or insurance advice. The Marketplace decides your eligibility and savings. We do not sell insurance or choose plans.