Renewing Marketplace Coverage

I tried to renew my same plan for next year, but the insurance company says I missed a payment and won’t let me continue coverage next year until I pay the back premium I owe. Can they do that?

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Yes, in some circumstances.  Insurers are allowed to require people who owe back-due premiums from the past 12 months to repay the premium debt before they will renew coverage for another year.  However, certain restrictions on this practice apply.

First, each insurer must decide whether to adopt this practice and, if it does, must apply it consistently for all enrollees.  In addition, states can prohibit or limit this practice by insurers.

Second, the insurer is required to provide you with prior notice that it intends to take this action.

Third, the insurer can only require you to repay the net amount of back premium – the full premium amount minus the amount of premium tax credit the federal government paid the insurer on your behalf – for one month.  People who receive premium tax credits in the Marketplace must be given a 3-month grace period to catch up if they miss a premium payment.  Coverage can be cancelled, retroactive to the end of the first month of the grace period, for people who don’t get caught up.  Insurers that cancel coverage for nonpayment are allowed to keep the premium tax credit for that first month.

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.

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Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.