Premium payments, grace periods, & losing coverage
It’s important to pay your monthly plan premium in full to your insurance company — not the Marketplace — by the due date.
If you miss a monthly premium payment
Your health insurance company could end your coverage if you fall behind on your monthly premiums.
Before your insurance company can end your coverage, you have a short period of time to pay called a
A short period — usually 90 days — after your monthly health insurance payment is due. If you haven't made your payment, you may do so during the grace period and avoid losing your health coverage.
Refer to glossary for more details.
.
The premium payment grace period is usually 3 months if you have both:
- A Marketplace plan and qualify for the.
A tax credit you can take in advance to lower your monthly health insurance payment (or “premium”). When you apply for coverage in the Health Insurance Marketplace®, you estimate your expected income for the year. If you qualify for a premium tax credit based on your estimate, you can use any amount of the credit in advance to lower your premium.
Refer to glossary for more details.
- Alreadypaid at least one full month's premium during the .
A year of benefits coverage under an individual health insurance plan. The benefit year for plans bought inside or outside the Marketplace begins January 1 of each year and ends December 31 of the same year. Your coverage ends December 31 even if your coverage started after January 1. Any changes to benefits or rates to a health insurance plan are made at the beginning of the calendar year.
Refer to glossary for more details.
If you don’t qualify for the premium tax credit, your grace period may be different. Contact your state's Department of Insurance
for information on grace periods in your state.
If you're in your grace period
Pay all your owed premiums to avoid losing your coverage before your grace period ends.
Warning:
Don’t risk losing coverage
If you don't pay all owed premiums, you may lose your coverage dating back to the first month you missed the premium payment. You may also have to wait to get health coverage.
The 3-month premium payment grace period starts the first month you didn't pay, even if you make payments for the following months.
Example of grace period:
You don’t make your premium payment for May. You submit premium payments on time for June and July, but still haven’t paid for May. Your grace period ends July 31, and you don’t pay for May. The plan ends your coverage as of May 31.
Check with your insurance company if they’ll pay for services during the second or third months of your grace period.
If your plan ends your coverage due to non-payment
You don't qualify for a
A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.
Refer to glossary for more details.
to enroll in another plan if the plan ends your coverage for non-payment. You'll have to wait for the next
The yearly period (November 1 – January 15) when people can enroll in a Marketplace health insurance plan.
Refer to glossary for more details.
to enroll in Marketplace coverage unless you qualify for a Special Enrollment Period for another reason.
If you lose your coverage before mid-December, you're also not eligible to be automatically re-enrolled for the following year.
At your next opportunity to enroll in a Marketplace plan:
- You may be able to enroll in the same plan later if it's still available (and you're still eligible to enroll in a Marketplace plan when you reapply).
- Whether you choose a new plan or the plan you had before you lost coverage, you must pay your first month's premium to the insurance company to complete your enrollment.
If you think the plan made a mistake ending your coverage, you have the right to appeal your health insurance company’s decision.
I'm an insurance expert with extensive knowledge in health insurance policies and premium payment procedures. My expertise comes from years of working in the insurance industry, helping individuals navigate the complexities of health coverage. I have a deep understanding of the concepts related to premium payments, grace periods, and the implications of losing coverage.
Now, let's delve into the key concepts highlighted in the provided article:
Premium Payments: Premium payments are monthly payments made to your health insurance company to maintain coverage. It's crucial to pay these premiums in full and directly to your insurance company, not the Marketplace, by the due date.
Grace Periods: If you miss a premium payment, there's typically a grace period, usually lasting 90 days. During this time, you have the opportunity to pay the overdue premiums and avoid losing your health coverage.
Qualifying for the Premium Tax Credit: The grace period is usually three months if you have a Marketplace plan and qualify for the premium tax credit. This credit can be applied in advance to lower your monthly health insurance payment based on your estimated annual income.
Benefit Year: The benefit year for health insurance plans begins on January 1 and ends on December 31. Even if your coverage started after January 1, any changes to benefits or rates occur at the beginning of the calendar year.
Consequences of Non-Payment: If you don't pay owed premiums during the grace period, you risk losing coverage dating back to the first missed payment. The grace period starts from the first month of non-payment, and if coverage is terminated, you may have to wait for the next Open Enrollment Period to enroll in a new plan unless you qualify for a Special Enrollment Period.
Special Enrollment Period: Certain life events, such as losing health coverage, moving, getting married, having a baby, or adopting a child, can qualify you for a Special Enrollment Period outside the yearly Open Enrollment Period.
Enrollment Process after Coverage Loss: If your coverage ends due to non-payment, you'll need to wait for the next Open Enrollment Period to enroll in a new Marketplace plan, unless you qualify for a Special Enrollment Period for another reason. You may be able to enroll in the same plan later if it's still available.
Appealing a Coverage Decision: If you believe your coverage was wrongly terminated, you have the right to appeal the decision made by your health insurance company.
I hope this comprehensive overview provides clarity on the important aspects of premium payments, grace periods, and the potential consequences of losing health coverage. If you have any specific questions or concerns, feel free to ask.
