Renewing Marketplace Coverage

I am covered in a Marketplace health plan now and want to keep the same policy for next year, but I am behind on my premium payments. I haven’t paid the October premium; I know I have a grace period, through the end of December, to get caught up. Meanwhile, if I at least pay my January premium, will that ensure my coverage remains in effect for next year?

It depends.  First, be aware that if you don’t get caught up with premium payments by the end of the grace period, your current coverage will be terminated retroactive to the end of the first month of the grace period, any claims made during the second or third month of the grace period will not be paid, and you will still owe the insurance company for the October premium.

If your insurance company has adopted the new premium-debt repayment policy, it can apply your January payment to the October bill and still require you to pay the January premium before it will let next year’s coverage take effect.  To do this, the insurance company must have provided you notice that it is adopting the premium-debt repayment policy.  The notice must explain the deadlines for paying premiums and repaying premium debt and the consequence for not meeting these deadlines.  Contact your insurance company if you have questions about this notice or your bill.  You can also contact the Marketplace or your state insurance regulator if you have questions or concerns about this new policy.

If your insurance company has not adopted the new premium-debt repayment policy, it may accept your January payment to start your coverage for next year.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.