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What happens if I don’t make my premium payment by the end of the grace period?

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Image: DC Studio / stock.adobe.com

What happens if I don’t make my premium payment by the end of the grace period?

Q. What happens if I don’t make my premium payment by the end of the grace period??

A: If you fail to pay your premiums and exhaust the grace period for plans offered in a health insurance marketplace, you will lose your insurance coverage. The grace period is either one month or three months long, depending on whether or not you’re receiving subsidies and whether or not you’ve paid at least one health insurance premium so far during the year.

The three-month grace period applies to those who receive federal subsidy assistance in the form of an advanced premium tax credit and who have paid at least one full month’s premium within the benefit year (as described below, there’s an exception to this rule when coverage is auto-renewed for the new year; the grace period can carry over from the end of one year into the next year, even if premiums have not yet been paid for the new year).

For those without a subsidy, the grace period is generally one month, although this can vary from one state to another, since it’s regulated at the state rather than the federal level. This applies to plans purchased on-exchange without a subsidy, as well as plans purchased outside the exchange, since none of those plans qualify for subsidies.

For enrollees who are not receiving subsidies, if payment is not made prior to the end of the grace period (typically one month), coverage will be retroactively terminated to the end of the month for which a premium was last paid.

For enrollees who are receiving subsidies (and who have effectuated their coverage by paying at least one month’s premium), if their premiums go past three months overdue, the coverage will be terminated retroactive to the end of the first month of the grace period. So if a subsidized enrollee pays the January premium but then doesn’t pay February, March, or April, the coverage would then be terminated as of the end of February.

In order to keep coverage in place past the end of the grace period, you have to be fully paid-up by the end of the grace period. In other words, the grace period does not allow people to be perpetually three months behind on their premium payments. If you get behind on your premiums (and you’re receiving subsidies), you’d need to fully pay premiums for all three months of the grace period in order to retain your coverage.

If your coverage is terminated back to the end of the first month of the grace period due to non-payment of premiums, it’s important to note that you’re not eligible for a premium tax credit (subsidy) for that first month of the grace period. New York State of Health (the state-run exchange in New York) explains this with an example in question 12 of their FAQs about Form 1095-A. So the premium tax credit that was paid on your behalf for the first month of the grace period will need to be paid back when you file your taxes, even though your coverage didn’t terminate until the end of that first month of the grace period (ie, claims incurred during that month would have been paid by your carrier).

The IRS has also prepared FAQs about Form 1095-A, and notes that it’s common for people to receive an incorrect Form 1095-A if their coverage was canceled retroactively due to non-payment of premiums; in that case, the exchange will issue a corrected Form 1095-A. If in doubt, contact the exchange and/or your tax advisor.

Individuals who lose coverage in the marketplace due to non-payment of premiums will not be able to rejoin a marketplace health plan until there is a new open enrollment period, unless they experience a qualifying event (and most qualifying events have a prior coverage requirement; most are designed to allow a person to change coverage, rather than go from being uninsured to insured). During the time that you’re uninsured, you’ll be responsible for paying any medical bills that you incur.

Can I enroll again during open enrollment if my old plan terminated for non-payment of premiums?

Open enrollment has generally allowed people a chance to start over each year with new coverage, regardless of whether the prior year’s coverage was terminated during the year due to non-payment. The market stabilization rules that were finalized by HHS in 2017 made some changes that allow insurers to recoup past-due premiums when people try to re-enroll during open enrollment. But HHS has proposed a reversal of those rules as of 2023.

The new rules are described in more detail here, but essentially, if your coverage is terminated for non-payment of premium and you then enroll in a plan offered by that same insurer within 12 months of your prior plan being terminated, the insurer can require you to pay your past-due premium before effectuating your new policy (but again, HHS has proposed a rule change that would prevent this as of 2023).

If your coverage was already terminated for non-payment of premiums, the most you would owe in past-due premiums is one month of premiums, as your plan termination date would have been the end of the first month of the grace period. If you weren’t getting a premium subsidy, you wouldn’t have any past-due premiums, because your plan would have been terminated to the last date that you had paid for the coverage (insurers cannot assess past-due premiums for months after the coverage termination date).

But if you’re still in the grace period when you’re re-enrolling (ie, your coverage hasn’t yet been terminated), you could owe up to three months of past-due premiums if you’re re-enrolling with the same insurer.

You can enroll in a plan with a different insurer without having to pay up your past-due premium from the prior year, although another insurer owned by the same parent company that owned your previous insurer would be able to require you to pay the past-due amount. And in some areas of the country (particularly rural areas) there is just one insurer offering plans. This makes it impossible to avoid the past-due premiums rule if the insurer chooses to implement it.

In June 2021, HHS noted that they were reconsidering this rule to determine “whether it may present unnecessary barriers to accessing health coverage.” And the proposed Notice of Benefit and Payment Parameters for 2023, issued in early 2022, calls for the rules to return to the way they were prior to the Market Stabilization Rule (in other words, insurers would no longer be allowed to apply premium payments to past-due premiums if a person enrolls in the same plan, or another plan issued by that insurer, during open enrollment).

What if I’m in the grace period during open enrollment?

HealthCare.gov enrollees who are in the grace period at the end of the year need to be aware that the grace period does not reset at year-end if the plan is auto-renewed.

So for example, if you didn’t pay November and December premiums, and then your plan is auto-renewed for January, you can’t just pay January’s premium to keep your coverage going for the coming year. You’d have to pay all three months (November, December, and January) by the end of the three-month grace period that began when you missed the November payment. The total amount has to be paid in full by the end of the grace period, or else your coverage will be terminated back to the end of November (this is the same system that would be used regardless of the time of year that the non-payment of premiums occurs).

However, if you enroll in a different plan for the coming year (rather than letting your plan auto-renew), your old plan would terminate back to the end of November, and your new plan would start January 1, as long as you pay January’s premium.

Although a person generally has to have made at least one premium payment during the current benefit year in order to be eligible for a grace period, that is not the case if they’re in a plan that has been auto-renewed. CMS has clarified (here and here) that if a person’s plan is auto-renewed (either the same plan, or a crosswalked plan), that’s considered the same plan they already had, meaning that it has already been effectuated and the same grace period is available as would be available at any other time of the year.

So for example, consider a person who is receiving a premium tax credit, has paid for their coverage through December, and is auto-renewed for the coming year, but then fails to make their January premium payment. Although they haven’t made a payment in the current benefit year, they are still eligible for the same three-month grace period that they would have been eligible for if their premium lapse had happened a few months earlier.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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John P Moss
John P Moss
2 years ago

I was automatically re-enrolled in my Cigna plan this January 2020. I never paid my premiums and, as far as they were concerned, I still qualified for a healthcare subsidy. In the meantime, I purchased a regular policy from an insurance agent without a subsidy. I assumed that the plan would terminate itself with no penalty. Now it is May 11th and my Cigna plan just terminated from lack of payment on April 29th (when an extended grace period ended). Cigna says we owe them $3800 for Jan thru Apr premiums and those premiums received a healthcare subsidy of $754. According to this article, they should have at most retroactively terminated the policy back to January or maybe February. But I am most worried about the tax subsidy that I may owe, even though I never used the insurance. I have been back and forth between Cigna and the Marketplace.gov and they keep shutting me down, saying they can;t do anything and we owe from January through the end of April. What are my options now?
John in Missouri

Louise Norris
Louise Norris
2 years ago
Reply to  John P Moss

John, I would recommend that you reach out to the Missouri Department of Insurance to see if they have any advice or guidance for you. In this situation, there should not have been a 90-day grace period, because you didn’t pay any premiums during the plan year, which began in January. The 90-day grace period for people with premium subsidies only applies if you’ve already paid at least one premium during the year, to effectuate your coverage. If no premium is paid even for the first month, the coverage should not have been effectuated, which means it was never in force. See more info on that here: https://www.healthcare.gov/apply-and-enroll/health-insurance-grace-period/
Cigna’s records should show that your plan was never effectuated, which would mean no premium subsidies should have been paid on your behalf. But if they did effectuate your plan for 2020, it should have retroactively terminated to the end of the month after you last paid a premium, which would mean the end of January. People in this scenario do have to pay back that month’s premium subsidy, but again, I don’t think that should be the case for you, since you never paid any premiums for 2020.

Kit
Kit
2 years ago

So here’s my situation. I had a subsidy from January to March. However in March I got notice from the Market Place that they had not received mg income info?? I didn’t argue and just sent it again. Then they come back and say not received in time! So I lose my subsidy. BCBS now charging me a $3K premium!! I appealed to the market place exchange and still waiting to hear back. However now I find my bcbs Insurance plan terminated! I need my insurance as my wife has an upcoming surgery. What can I do?

Louise Norris
Louise Norris
2 years ago
Reply to  Kit

Kit,
I’m sorry you’re in this situation. Did you use a broker to help with the enrollment process? If so, I would recommend contacting the broker asap, as they’ll be able to help you address this situation. If not, you’re going to need to work with both the marketplace and BCBS to get this sorted out. If you didn’t request an expedited appeal, you’ll want to do so, given the upcoming surgery: https://www.healthcare.gov/marketplace-appeals/expedited-appeal/ (if you’re in a state that runs its own exchange, the appeals process is different, but you should still be able to request an expedited process).
The problem here started with the marketplace, and they’re ultimately the ones who will need to reinstate your subsidy and alert BCBS to the situation. But since BCBS terminated your plan (presumably for non-payment of premiums?), you’re also going to need to contact them. From our experience, they each might try to pass the buck to the other entity, so it’s important that you document everything, including the name of the people you speak with and the incident/ticket numbers for your calls. You might even be able to get a representative from the marketplace and BCBS on a three-way phone call, which could help to sort it out.
Best of luck!

zoe
zoe
1 year ago

I am coming up on Medicare August 1. I have a very expensive plan from Kaiser right now (through Covered CA but they don’t pay anything) and it has a $6500 deductible. I haven’t paid June yet ($850) and I don’t want to pay July but…I don’t want to be completely without. What I’m hoping is I can squeak by in the grace period and if something happens I’ll pay and if I can make it to August without just get straight on Medicare. Do you think that is possible. (I feel dishonest but the payments have been killing me.)

Josh Schultz
Josh Schultz
1 year ago
Reply to  zoe

It’s never recommended to go without health coverage — but your concerns about premium costs are understandable. Medicare will be far more affordable once you get there. This article should answer your questions — although it seems like the answer may depend on whether you receive advance premium tax credits (APTC), which would extend your grace period from 30 to 90 days. If this is the case and you choose to drop your coverage as you mention here, remember that you’ll have to repay the IRS for APTC used in the first month of the grace period — meaning you’d only save a little more than one month worth of premiums.

Josh Schultz
Josh Schultz
1 year ago
Reply to  zoe

Your grace period is only 30 days if you’re not receiving subsidies — which means you probably wouldn’t be able to do this. However, if you’re receiving advance premium tax credits (APTC), your grace period is 90 days, and you would be able to delay your premium payment in the way you describe. Your coverage would continue through the end of the first month of the grace period if you receive APTC, which means you would have to repay APTC for that month — and probably wouldn’t save that much money.

Karin
Karin
1 year ago

I have until August 30 to elect Cobra and then have a 45-day grace period to pay. If I elect Cobra on August 30 and then become employed and receive health coverage before Oct 15 and have NOT paid Cobra, will that affect my credit rating or my ability to qualify for coverage with the same carrier?

Jeff
Jeff
1 year ago
Reply to  Karin

I’m wondering the exact same thing. Did you gen an answer? After being laid off I signed up for COBRA coverage for the month of October. I have not paid my premium (yet) and my coverage through my new employer starts the last week in October. Since we didn’t use our COBRA insurance for any services during the month, I’m wondering how not paying the COBRA premium will affect me (my new insurance is with a different provider).

Louise Norris
Louise Norris
1 year ago
Reply to  Jeff

Jeff, please see the response above. If you don’t make the payment to effectuate your COBRA coverage, your coverage will be terminated back to the date that your group coverage would otherwise have terminated without COBRA. So you’ll have a gap in coverage for most of October, but no past-due premiums that need to be paid, since the plan would not have been providing you with coverage during October.

Louise Norris
Louise Norris
1 year ago
Reply to  Karin

We would advise you to reach out to your state’s insurance department to make sure you understand any specific rules that your state may have. But in general, if you never effectuate your COBRA coverage (ie, you don’t make your premium payment), there’s no debt owed to the insurer because they never actually provided any coverage. Your coverage would simply terminate back to the date that your group plan was in force with premiums paid-up.
The scenario described in this article (in which a person could have a past-due premium that needs to be paid before a new plan could be effectuated) happens when an individual market plan is terminated due to non-payment of premiums, but the grace period results in the policy being terminated a month AFTER the premium was last paid-up, or when the grace period is ongoing during the time the person is trying to re-enroll and their coverage has not yet been terminated, meaning that they could owe up to three months of premiums. In those scenarios, the person has a debt due to the insurer. But if the coverage is never effectuated, there’s no debt due because no coverage was ever provided.

Cheri
Cheri
1 year ago

I paid for Cobra through 12/31/20. I had a doctor’s appt on 12/28/20 which was not billed until 2021. Who is responsible to pay the bill?  

Louise Norris
Editor
1 year ago
Reply to  Cheri

Your COBRA plan should cover the bill (assuming you’ve met your cost-sharing obligations), since you were covered under that plan at the time the service was received.

Kathleen
Kathleen
1 year ago

Hi, I thought I was set up for automatic payment on my insurance premiums (NY state market place policy – United Healthcare). Today when I checked, I realized that I did not set it up correctly and I was two days after the grace period. I paid my full bill today (3/2) and the grace period ended on 2/28. The payment shows as submitted but is still processing. Is there anything I can do to help my case so that my insurance is not terminated? Thank you

Louise Norris
Editor
1 year ago
Reply to  Kathleen

We advise that you reach out to both NY State of Health and UnitedHealthcare as soon as possible to check on this. Since the grace period ended on a weekend, it’s possible they’ll be flexible with you on this.

Stacey Ann
Stacey Ann
1 year ago

I enrolled in Molina for 2020, my premium with my tax credit was $25. My last payment was in July 2020 and I haven’t made a payment since. I received a letter now 03/08/2021 saying I owe over $1.4k. I called marketplace and cancelled the plan, I was unaware they were still charging me month to month and took away the tax credit making my premium $300 and auto-renewed it. I’ve had insurance with my job since September 2020. What can I do?

Louise Norris
Editor
1 year ago
Reply to  Stacey Ann

You’re probably in luck in terms of the tax credit, as the American Rescue Plan (expected to be signed into law this week) includes a provision to eliminate excess premium subsidy repayments for the 2020 tax year (in other words, the IRS won’t make you pay back the tax credit). See Section 9662: https://www.congress.gov/bill/117th-congress/house-bill/1319/text#toc-H43439D12D8DE48B4A7B8D83031FDFC2E
Molina should have canceled your plan three months after your last payment, with the termination date effective one month after your last payment. That would have meant that you owed at most one month’s premium to Molina. You can reach out to them and ask them why they didn’t do that, as that’s the standard process when a subsidized marketplace enrollee gets behind on premiums.

Alyssa Byars
Alyssa Byars
1 year ago

I accidentally enrolled in coverage for my husband and I through the marketplace for Molina healthcare. The payment for this coverage being $300 a month each. For some reason when I enrolled they set my coverage back to January 8th. I applied only a week or so ago so mid march. So, they are saying I owe these payments for January-March. I would not have even qualified for insurance as I was enrolled in Medicaid for the month of January until the day I applied. I tried to cancel because my Medicaid was reinstated due to the pandemic until further notice. Is there anything I can do? Will I actually have to pay back for each of these months. I don’t have the money to make $600 a month insurance payments.

Louise Norris
Editor
1 year ago
Reply to  Alyssa Byars

If you don’t make any payments at all, your coverage will simply not take effect, which means you won’t owe anything. But you should keep contacting the marketplace and Molina to get this resolved and ensure that no premium tax credits are being mistakenly paid on your behalf.

Erick Cruz
Erick Cruz
1 year ago

in am elegible for tax credit, however since i am enrolling during a special enrollement period they are telling me that i have to pay for the first month full premium ($900. 00 withouth applying subsidy). Do i get a refund for this first month at any point? Or doni lose this money even if i am approved for tax credit?

Louise Norris
Editor
1 year ago
Reply to  Erick Cruz

It’s possible you’re enrolling before the new subsidy amounts are available in your state’s marketplace, as these are being rolled out over the next few weeks (they debuted on HealthCare.gov as of April 1). If so, yes, you’ll be able to claim the additional premium subsidy when you file your 2021 tax return.
When you reconcile your premium tax credit on your tax return, the IRS will send you any additional amount that you’re owed above and beyond the amounts that were sent to your insurer during the year. The additional premium tax credits for 2021 are retroactive to the start of the year or the start of a person’s marketplace coverage if they enrolled after the start of the year (the usual caveats apply: You’re not eligible for a subsidy for any month that you were eligible for Medicaid or a comprehensive employer-sponsored plan that’s considered affordable)

JOSEPH HESSLING
JOSEPH HESSLING
1 year ago

Even though I terminated my payments, the insurance (CareSource) continues to bill the monthly premiums. Healthcare.gov says I owe the payments because I did not notify them to cancel the policy. My last payment was for 10/31/2020, and just received a bill in 04/2021 for the month of November. No claims were made.

Louise Norris
Editor
1 year ago

As you’ve probably discovered from this, simply ceasing to pay premiums is not an ideal way to go about cancelling your health coverage. You do need to contact the exchange/marketplace in order to officially terminate your coverage. By now, your policy should have terminated due to lack of payment, but it sounds like they’re still seeking payment for November, as your coverage didn’t officially terminate until one month into your grace period (I’m assuming you were receiving a premium subsidy in 2020, and thus had a three-month grace period with coverage terminated back to the end of the first month?)
The good news is that if a premium subsidy was being paid on your behalf in 2020, you do not have to repay the excess subsidy to the IRS: https://www.healthinsurance.org/blog/how-the-covid-relief-law-will-rescue-marketplace-plan-buyers/ Normally, you would have had to repay the IRS for the subsidy that was paid on your behalf for the first month of your grace period, as described in the article above.

JOSEPH HESSLING
JOSEPH HESSLING
1 year ago
Reply to  Louise Norris

Thank you for the response. That was what made it hard to understand. There was no subsidy involved. It needed to cover a two month waiting period before the insurance kicked in for my new job on 11/01. I was told (incorrectly) to just stop making payments to CareSource. When I received a bill for November, I called CareSource, and they told me to call the MarketPlace. I called them, and they said I could not do a retroactive cancellation unless it met one of three criteria (all things like a natural disaster that prevented me from calling). So they cancelled as of 11/17. I filed an appeal with CareSource, and it was turned down, and I was told I owed until 11/17 – a partial payment. It is now going to collection. In the meantime, I spoke to several agents who have stated not paying premium should have cancelled the plan.

Mark Wilson
Mark Wilson
11 months ago

You need to be careful with the wording in the article about grace periods. You say it’s 3 months, but I’ve found that some insurance companies use 90 days instead. Your last day to pay might not be the last day of the third month of the grace period. It seems to be completely dependent on how each insurance company interprets the regulations.

Louise Norris
Editor
11 months ago
Reply to  Mark Wilson

Technically, the language in the ACA says three months: http://housedocs.house.gov/energycommerce/ppacacon.pdf [Section 1412(c)(2)(B)(iv)(II)] But yes, if an enrollee is planning to pay up right at the end of the grace period, we’d recommend checking with the state insurance department of the insurer to see how they interpret the statute.

John
John
2 months ago

I was laid off July 2021. Employer was supposed to pay for August and September 2021 but I don’t think they did. I submitted my COBRA election a week after I got laid off but Blue Shield said they never got it possibly because no one was at their building to accept the mail. I, then elected last day via e-mail for October. September, my new job insurance kicked in. So I never made any claims August-October and I just assumed I never had coverage from August-September. Do I need to make any payments for COBRA? I don’t think the employer paid even though I submitted the summary of dues to them. It’s 3/2022 now. The Blue Shield says nothing about dues owed. I stopped getting Blue Shield letters.

I totally forgot about it until now when I have to select which months I had HDHP in my taxes.

Louise Norris
Editor
2 months ago
Reply to  John

Electing COBRA is just the first step; you also have to start paying the premiums in order to activate it. If you never paid for your COBRA, it would not have taken effect and your coverage would just have terminated as of either the end of July or the end of September (depending on whether the employer paid for those extra two months of coverage). So no, you should not owe any past-due premiums at this point.

Jason
Jason
2 months ago

You stated that “the one-month grace period also applies to plans purchased outside the exchange, since none of those plans qualify for subsidies.” Where is the regulatory requirement/citation for the ‘off-exchange grace period’ located?

Louise Norris
Editor
2 months ago
Reply to  Jason

Hi Jason,
I’ve updated this article to clarify that states set this rule themselves; the federal government only regulates the grace period for people receiving premium subsidies. For those who don’t receive a subsidy (on-exchange or off-exchange), state rules apply. I’ve only ever seen 30-day or 31-day grace periods, but I haven’t looked at every state. So it’s possible that there are states that have different grace periods. In any case, the rules would be outlined in each state’s regulatory/statutory language.

Christine A
Christine A
2 months ago

I paid my February premium on 2/27 online and got a confirmation number with the date and time the payment was made. HealthNet Ca didn’t post it until 3/1 and terminated me but I did not know this until I received their letter dates 3/1 but received on 3/11 which was late on a Friday. I called Monday morning for them to reinstate it back to 3/1 and as of today 3/24 they are still working on it and told me I have no coverage. I am so angry and feel my hands are tied and it was their error.

jennifer
jennifer
1 month ago

I paid the 1st month of COBRA coverage. I enrolled with marketplace instead of keeping COBRA the following month. The pharmacy billed my COBRA and they paid the claim a few weeks ago which I just discovered this happened. Apparently I am in a grace period that I was unaware of. COBRA shows I owe the month premium. Can they force me to pay back the prescription ? or the premium ?

Louise Norris
Editor
1 month ago
Reply to  jennifer

If you don’t make the COBRA payment by the end of the grace period, your COBRA will terminate back to the last date that your premiums were paid up (meaning the end of the first month of COBRA coverage, since you just paid for one month). The COBRA health plan could then rescind payment for the prescription, and the pharmacy would send you a bill for it instead.

But if your new marketplace plan was already in place when you got the prescription, you can provide that coverage information to the pharmacy and ask them to rebill it to your new health plan instead. You’ll owe whatever cost-sharing is required under the new plan.

Wendy
Wendy
1 month ago

My daughter recently left her job. Last day of employment was March 4. She started a new job on March 14, and her new insurance (which will be from the same provider, BCBS) takes 90 days to become active, on approximately June 14. . She has received a COBRA Continuation Coverage Election form that states the first day of COBRA is March 5, and last day to elect COBRA is May 10. If she elects and submits the election form on May 9, as I understand, she will have 45 days grace period to submit her first premium, which would be June 23, and her new insurance policy would have already gone into effect. Am I correct in my understanding that as long as she has made no claims at that time, she could, theoretically, choose not to pay the initial premium as she would no longer need the coverage? And this would have no negative effects on her credit score, or other consequences? Thank you for your advice.

Louise Norris
Editor
1 month ago
Reply to  Wendy

Yes, this is correct. Here’s more information about COBRA deadlines and rules: https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-health-coverage-consumer.pdf

If she elects COBRA on May 10, she’ll then have 45 days to pay her initial premium. If she ends up needing medical care between now and June 14, she’ll be able to pay all COBRA premiums that are due, and her coverage will be effective back to March 5. But if she doesn’t end up needing any medical care during this time, she can choose to not pay her COBRA premium and her old employer-sponsored coverage will have just terminated as of March 4. Nothing is sent to collections or reported to credit bureaus – you simply lose your access to COBRA at that point.

Preet
Preet
1 month ago

Hello, So I signed up for a health insurance plan through Pennie (healthcare website)…they gave me a subsidy of about $1300 which I had to submit my tex documents for. I had a vacation planned and I went on vacation out of country and didn’t receive the notices on providing the income proof…they cut my subsidy and the insurance company sent me a bill for $2700 premium for 2 months. Now when I call them they keep saying I have to pay that bill but I don’t have the funds to pay it just like that. What are my options and who can I speak to in order to clear everything out.

Louise Norris
Editor
1 month ago
Reply to  Preet

This article has some information about where you can turn for help: https://www.healthinsurance.org/faqs/who-can-help-if-i-have-a-problem-with-my-aca-compliant-coverage-or-exchange-enrollment/ There are limited windows for submitting requested documentation, but if you can prove that you were out of the country for the entire time, they may be willing to give you an extension.

Roger
Roger
29 days ago

I didn’t pay by end of the 30 days grace period. My insurer paid for my physician visits & prescriptions during the grace period. Will I be responsible for the bills that my insurer paid during the grace period?

Louise Norris
Editor
27 days ago
Reply to  Roger

If your plan only had a 30-day grace period and you didn’t pay your premium during that time, it would terminate back to the last date that you were paid up. That would mean that the insurer can recoup the money they sent to your medical providers during that period, because you technically didn’t have coverage. If that happens, the providers would then bill you for the services.

Mike
Mike
25 days ago

My 30 day grace ends on a Sunday- The 1st. I’m trying to make a payment but cannot find the website I’ve used since it’s a tricky one. I even searched my computer history and looked at the packet with no luck. No website listed. I’m calling Monday to pay. Will they terminate me? What should i say for them to understand.

Louise Norris
Editor
24 days ago
Reply to  Mike

Mike, I hope they’ll work with you on this and allow your coverage to continue. Unfortunately, there is no requirement that they do so, as issues like this are what the grace period itself is for. But hopefully they’ll be understanding when you explain the efforts you went through in trying to pay your bill online on before the grace period ended.

Ann
Ann
7 days ago

I had a Pennie plan while unemployed. When I started working Pennie terminated my plan and opened a new one. I got a bill stating in order to begin your coverage pay your first premium. However, turns out they count my firs premium as the plan I had while unemployed that they just terminated and wiped out all out-of-pocket contributions. I appealed and lost because even though the language stated otherwise, it truly wasn’t a new plan.
I appealed in December 2021, got an appeal hearing for March 2022, got a decision the last few days of April 2022 that I owe the premium where I received tax credits from October 2021. I called Blue Cross right after I lost my appeal and paid it over the phone. The money was taken out of my bank account. I contacted Pennie for a corrected 1095-A. They sent me a “New” 1095-A but it still has a zero in the first two columns as if i never paid the premium. I filled for an extension because of having to wait for the appeal decision. Have I lost the right to have a corrected 1095-A? Will they send me one I can only use in 2022?

Louise Norris
Editor
7 days ago
Reply to  Ann

Ann,
I’m sorry you’re having to deal with all of this. To clarify, you did end up paying monthly premiums for the coverage you had through Pennie in 2021, but you paid it all in one chunk in April 2022? And now Pennie has sent you a new 1095-A, but it doesn’t reflect the fact that you paid premiums for your coverage? (in other words, the 1095-A indicates that the full cost of your coverage was paid with advance premium tax credits?)

If that’s the case, it certainly seems like Pennie needs to send you yet another corrected 1095-A. But it’s possible that Blue Cross hasn’t let Pennie know that you paid them for your coverage, and so Pennie’s system doesn’t reflect that.

One other point: You mentioned that you had a Pennie plan while you were unemployed. Were you receiving unemployment compensation at any point in 2021? If so, you should have qualified for a premium tax credit that would have paid the full cost of the benchmark plan (second-lowest-cost silver plan). That would have been applicable for the full year, even if your income increased later in the year (with the caveat that you’re never eligible for a premium tax credit in a month that you’re eligible for an employer-sponsored plan, but it sounds like your new job didn’t come with an offer of employer-sponsored coverage, since you still had coverage through Pennie at that point?) I’m not sure if this would have been applicable in your case or not, as it would have depended on whether you were receiving unemployment compensation last year. But here’s more info about that, just in case: https://www.healthinsurance.org/blog/american-rescue-plan-delivers-0-silver-premiums-to-unemployed/

Denise
Denise
2 days ago

Hello, I am in the special enrollment period to purchase an ACA plan due to loss of job coverage. I just signed up for a (subsidized) plan in North Carolina. I haven’t yet paid the premium because I am looking for another job that may have benefits. The ACA plan is due to start June 1. I haven’t been able to find information if I can delay that FIRST payment without the plan terminating during the first month? I will pay the premium (or cancel the plan) as soon as I know one way or the other if I have a new job. Do I have a 30 day grace period to pay the first premium? I do receive a subsidy.

Louise Norris
Editor
1 day ago
Reply to  Denise

No, there is no grace period for the first premium. So it’s due by whatever date the insurer has set as the deadline. If you don’t pay your premium by the initial due date, the plan will just never take effect. Assuming your 60-day special enrollment period was still ongoing as of June and you didn’t yet have coverage under a new employer’s plan, you could then reapply for another plan (but it would take effect July 1 instead).

Do you have an offer of COBRA from your previous job plan, and are you within 60 days of that plan ending? If so, you could potentially rely on the retroactive nature of COBRA to cover you for up to two months while you’re waiting for another job-based plan to start. This is because if you elect and pay for COBRA, it takes effect back to the date the plan would have otherwise ended, providing seamless coverage.

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