Late Paying Obamacare Health Insurance Premiums?

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You’re not the first person to be late paying your health insurance premium, and you won't be the last. However, since there are repercussions for being late, you need to understand what the rules are, how they apply to your situation, and what happens if you’re late paying your ​Obamacare health insurance premium.

When you get your health insurance through an Affordable Care Act health insurance exchange, how late health insurance premiums are handled depends on

  • Whether this is your first premium payment to initiate new coverage or a payment to continue coverage that’s already in force.
  • Whether or not you’re getting a subsidy to help pay for health insurance.

The rules are stricter for initial premium payments than for a monthly premium payment continuing your existing coverage. And the rules are stricter for those without subsidies, while those getting help paying their health insurance have a longer grace period.

Late Paying Your Initial Obamacare Health Insurance Premium

If you’re late paying your initial health insurance premium for a health insurance policy you’re buying through the exchange, your health insurance coverage won’t take effect. You’ll be uninsured.

In most cases, by the time this happens, the annual open enrollment period will be over, so you won’t be able to reapply immediately. Unless you qualify for a special enrollment period or for Medicaid, you won’t have another chance to sign up for health insurance until next year’s open enrollment. If you qualify for Medicaid, you may enroll throughout the year.

Late Paying Your Monthly Obamacare Health Insurance Premium

If you’ve already paid your first month’s premium and your health insurance has taken effect, you’ve passed the first hurdle. Now, you need to make monthly health insurance premium payments to keep that insurance policy active.

If you’re late paying your monthly health insurance premium, the rules are a little less strict than for the initial premium payment; there’s a grace period. How the grace period works depends on whether you’re getting help paying for health insurance or not.

No premium subsidy? Grace period is usually 30 days

If you’re not getting a premium tax credit health insurance subsidy, your health plan will generally cancel your coverage after your payment is 30 days late. You’ll have to pay the entire premium by the end of the 30-day grace period or you’ll be uninsured, with your coverage termination back-dated to the last day your premiums were paid-up (ie, to the start of the 30-day grace period).

Losing your health insurance because you didn’t make the premium payment doesn’t qualify you for a special enrollment period on the exchange, so unless you qualify for a special enrollment period triggered by something else, you'll have to wait until the next annual open enrollment period to re-enroll (and in most cases, eligibility to purchase coverage during a special enrollment period is now limited to people who already had health insurance coverage prior to the special enrollment period; opportunities to enroll during a special enrollment period after being uninsured are limited).

The one-month grace period typically applies to all plans purchased outside the health insurance exchanges, since premium subsidies are never available to offset the cost of those plans (the policies themselves are ACA-compliant, however, as long as they're individual major medical plans, as opposed to excepted benefits).

Receiving a premium subsidy? You have a 90-day grace period

If you’re getting a premium tax credit health insurance subsidy and you’re late paying for your health insurance, you have a 90-day grace period before your health insurance will be canceled. However, just because your health insurance wasn’t canceled during those 90 days doesn’t mean your health plan will actually pay for your medical care if you’re late paying your Obamacare premium.

For the first 30 days, you’re in arrears, your health plan will continue to pay health insurance claims for the health care services you get. If you get care after you’re more than 30 days late paying your premium but before you’re 90 days late, your insurer will notify your health care provider that you’re late paying your premium and those claims will be put on hold. Your health plan will wait to see whether you pay your premium or not before processing the claim.

If you get your premium payments back up to date, the insurer will process those claims and pay them as usual. If you don’t get your premiums fully up to date within the 90-day grace period, your health plan will cancel your coverage retroactive to the day you became 31 days late paying your health insurance premium. You’ll be uninsured as of that date, and the pending claims for services you got after that date will be denied.

And although you will have had coverage during the first month of your grace period, you'll have to pay back the premium subsidy that was paid on your behalf for that first month, if you didn't end up paying your portion of the premium for that month (overpaid premium subsidies are reconciled on Form 8962 when you file your tax return).

Re-enrolling after your plan is terminated for non-payment

In the early years of ACA implementation, there were concerns that people might game the system with the way the 90-day grace period was set up. To address some of this, the Department of Health and Human Services finalized a market stabilization rule in 2017 that included, among other things, the option for insurance companies to recoup past-due premiums before allowing an applicant to re-enroll.

If your coverage is terminated for non-payment of premiums and you then reapply for a plan from the same insurer within 12 months, the insurer can require you to pay your past-due premiums before letting you sign up for a new plan.

If you weren't getting a premium subsidy when your plan was terminated, you wouldn't have any past-due premiums, because your plan would have been retroactively terminated back to the last day you were paid-up. But if you were getting a premium subsidy, the insurer had to essentially give you one month of free coverage, because the termination date ends up being a month after the last date that your premiums were paid-up. It's the premiums for that month that they can require you to pay before allowing you to re-enroll, if the insurer has chosen to implement this rule.

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