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) 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.

Recent federal guidance allows insurers to extend the grace period an additional sixty days to consumers who are receiving premium tax credits, if requested or directed to do so by state authorities. If, due to a natural disaster in your area, you are uninsured for an extended period of time in 2018, you could qualify for an exemption from the ACA’s individual mandate penalty. For more information on how to request such an exemption, see this FAQ.

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 2019 coverage on the marketplace. Under a new policy, 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.

(82 Fed. Reg. 18346, April 18, 2017; Emergency and Major Disaster Declarations by the Federal Emergency Management Agency (FEMA) – Special Enrollment Periods (SEPs), Termination of Coverage, and Payment Deadline Flexibilities, Aug. 9, 2018)

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