QUESTION

I have a lot of unexpected bills because of a natural disaster in my area, and can’t afford to pay my marketplace premiums for the rest of the year. What are the consequences of not paying?

Post enrollment issues | Individual Health Insurance
ANSWER

If you decide you can’t afford to maintain your coverage this year, you should contact the Marketplace Call Center (HealthCare.gov) at 1-800-318-2596 (TTY: 1-855-889-4325) or your state health insurance marketplace as soon as possible to terminate your coverage and, if applicable, stop receipt of any premium tax credits. You should also contact your health insurance company to ensure your health plan is terminated. Make sure to document the dates of your contacts with the marketplace and the insurer.

In general, if you are receiving advanced premium tax credits, and have paid at least one month’s premium, insurers must provide a 90-day grace period to pay all premiums that are owed (if you are not receiving premium tax credits, grace periods may vary by state, but the general practice is a 31-day grace period). Federal guidance allows insurers to extend the grace period for consumers who are receiving premium tax credits, if requested or directed to do so by state authorities. In light of the natural disaster in your area, some insurance companies may voluntarily provide additional time for policyholders to submit late premium payments, and some states may require them to do so. You should contact your insurance company to determine whether they have changed their policies with respect to premium payments due to the natural disaster.

Note that not paying your health insurance premiums now and for the reminder of the year without terminating your plan could limit your ability to sign up for 2022 coverage on the marketplace. Insurers may condition your re-enrollment in their plan on payment of any outstanding premiums. However, insurers must provide notice of the new policy before they can apply it to you for failing to pay premiums. Also, the policy only applies to the insurer to whom you owe outstanding premiums. Other insurers offering plans in your area cannot deny you coverage for failing to pay premiums to another insurer. (CMS, 82 Fed. Reg. 18346, April 18, 2017; CMS, Emergency and Major Disaster Declarations by the Federal Emergency Management Agency (FEMA) – Special Enrollment Periods (SEPs), Termination of Coverage, and Payment Deadline Flexibilities, August 9, 2018; CMS, Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency, March 24, 2020).

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