Paying your bills…it’s crucial with insurance to avoid a LAPSE. Most of us make sure this does not happen by making those payments to avoid LAPSE.
However, Obamacare enrollees, those covered by the Obamacare entitlement are GIVEN SOMETHING THE REST OF US DON’T HAVE including federal contribution to their premium costs…A REALLY GENEROUS POLICY TO AVOID LAPSE IN THE EVENT OF NONPAYMENT (always seek legal advice for your situation).
For Obamacare consumers, it’s another superior benefit that most of us don’t have (go look up your own “GRACE” period). But there’s another group who’s not thrilled…DOCTORS. (LOOK UP AMA and Grace Period), who are afraid they’ll be left holding the bag for patient LAPSES IN COVERAGE.
THE LAWS: Affordable Care Act 1412 and 45 CFR 156.270
For consumers, the law is pretty clear. IF you paid YOUR SHARE OF PREMIUM FOR AT LEAST ONE MONTH IN A BENEFITS YEAR THEN you are eligible for the 90-day GRACE PERIOD. (Naturally paying your premium on time since you are getting federal bucks to help you would be best).
SEC. 1412. ADVANCE DETERMINATION AND PAYMENT OF PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS.
c) (2)PREMIUM TAX CREDIT (B) Issuer Responsibilities (iv) in the case of any nonpayment of premiums by the insured (I) notify the Secretary of such nonpayment AND (II) allow a 3-month grace period for nonpayment of premiums before discontinuing coverage
The Government will continue to pay THEIR SHARE of premiums to the insurance company for 90 days. As long as you paid at least ONE MONTH of the benefits year, you CANNOT be terminated before 90 days (like three missed payments). You still have insurance coverage as long as you PAY IN FULL by the time the 90 days is up.
That’s some darn good wiggle room that most people outside the entitlement don’t get.
But it’s not ALL roses. Under 45 CFR 156.270, “Termination of coverage for qualified individuals,” there are some things that are nonpaying enrollees can expect.
Under 45 CFR 156.270 (c) Termination of coverage due to non-payment of premium reiterates the grace period for exchange enrollees.
Under 45 CFR 156.270 (d) Grace period for recipients of advance payments of the premium tax credit the QHP, during the first 30 days the insurance company MUST pay all claims, so you have ONE missed payment you still get full coverage as long as you catch up with your policy by the end of the grace period.
But during the second and third months the insurance company can PEND your claims, meaning not do anything with them until you pay what you owe. This is significant because your doctors will also be told that you are in arrears and remember the AMA doesn’t like this rule so many doctors are being advised to collect payments from individuals in arrears up front which means that YOU MIGHT BE REQUIRED TO PAY CASH UNTIL YOU PAY UP and you’ll have to go to your provider for a refund and I’ve even seen it suggested that practices encourage people to PUT OFF their appointments until their insurance is straightened out.
YOU STILL HAVE INSURANCE DURING MONTHS TWO AND THREE, BUT YOUR PROVIDERS WILL KNOW YOU ARE IN ARREARS AND MIGHT MAKE IT MORE DIFFICULT FOR YOU TO OBTAIN CARE.
