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. 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 been in 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.

If you’re not getting a premium tax credit health insurance subsidy, your health plan will generally cancel your coverage after 30 days. You’ll have to pay the entire premium by the end of the 30-day grace period or you’ll be uninsured. Losing your health insurance because you didn’t make the premium payment doesn’t qualify you for a special enrollment period on the exchange.

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 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 retroactive to that date, and the pending claims for services you got after that date will be denied.

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