QUESTION

I’ve picked the plan I want. Now do I send my premium to the marketplace?

Individuals with no coverage | How Premium Tax Credits And Cost-Sharing Reductions Work
ANSWER

No, you will make your premium payments directly to the health insurance company. Once you’ve selected your plan, the marketplace will direct you to your insurance company’s website to make the initial premium payment. Insurance companies must accept different forms of payment and they cannot discriminate against consumers who do not have credit cards or bank accounts. The insurance company must receive and process your payment at least one day before coverage begins. Make sure you understand your insurance company’s payment requirements and deadlines and follow them so your coverage begins on time. Your enrollment in the health plan is not complete until the insurance company receives your first premium payment.

Note that since June 19, 2017, insurers can take into account any past due premiums you owe them for the previous 12 months of coverage. They can require you to pay those past due premiums before allowing you to re-enroll in their plan. This requirement does not apply if you are signing up for coverage offered by a new insurer and only affects the person responsible for paying premiums on the previous policy, not other family members enrolled in the plan. Further, the requirement only applies for the prior 12months of coverage and applies to both open enrollment and special enrollment periods. If the insurer is requesting payment of past due premiums for prior 12-month coverage, and you think this is an error, contact your state marketplace or state insurance department, a list of states’ departments of insurance is available under our Resources, Where to Go for Help.

If you have qualified to receive a premium tax credit and have chosen to receive it in advance, the government will pay the credit directly to your insurer and you will pay the remainder of the premium directly to the insurer. (45 C.F.R. § 155.305; 81 Fed. Reg. 94058, Dec. 22, 2016; 45 C.F.R. § 147.104; 82 Fed. Reg. 18346, April 17, 2017).

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