What happens if I’m late with a monthly health insurance premium payment?

It depends on whether you are receiving advanced premium tax credits. If you receive a premium tax credit, your insurer must provide a 90-day grace period to pay all past-due premiums. If the amount owed for all outstanding premium payments is not paid in full by the end of the grace period, the insurer can terminate coverage. However, the grace period only applies if you have paid at least one month’s premium within the current plan year.

During the first 30 days of the grace period, the insurer must continue to pay claims. However, after the first 30 days of the grace period, the insurer can hold off paying any health care claims for care received during the grace period. Some states require insurers to pay claims received past the first month of the grace period.

People who do not receive advanced premium tax credits generally get a much shorter grace period; currently, the general practice is 31 days, but it may vary by state. Check with your state department of insurance for more information about grace periods in your state.

In general, insurers are supposed to inform health care providers when someone’s claims are being held. If this happens, providers may request that you pay the full cost of care out of pocket, or they may not provide care until the premiums are paid up.

Check with your state department of insurance for more information about grace periods in your state and what charges you could be responsible for.