Tag: premium

Can immigrants get help paying premiums and/or cost-sharing for health insurance in the Marketplaces?

Lawfully present immigrants can get tax credits to help pay premiums and cost-sharing for health insurance through the Marketplaces. Like citizens, they can get tax credits to help pay premiums if they make between 100% and 400% of the federal poverty level. They can also qualify for cost sharing reductions if they make between 100% and 250% of the federal poverty level.  To get this help, they cannot be offered affordable health insurance through their job or be eligible for Medicaid.

Lawfully-present immigrants who make less than 100% of the federal poverty level  also can get help paying premiums and cost sharing if they cannot enroll in Medicaid due to immigration status. Many lawfully-present immigrants cannot enroll in Medicaid until they have been in the United States for five or more years.

Undocumented immigrants cannot receive help paying for premiums or cost sharing for Marketplace coverage and may not buy health insurance through the Marketplaces even at full cost.

I signed up for Marketplace coverage this year. I am sure I never missed a payment, but the insurer says I didn’t pay the October premium and won’t let me renew coverage for next year unless I repay it. Can I appeal this decision?

This is unclear.  So far, the federal government has not established a clear appeals process for problems that arise under the rule that permits insurers to refuse to renew Marketplace coverage for nonpayment.  It is important that you sign up for coverage before the end of Open Enrollment.  At this point, options to consider include:

  • Ask your insurer to reconsider. Be sure to present your cancelled check or other proof that you paid.
  • Report this problem to the Marketplace and to your state insurance regulator and ask their help resolving the problem
  • Review Marketplace plan options offered by any other insurers and consider signing up for one of those if you can’t get this problem resolved before December 15.

The Marketplace said I must submit additional information to document my eligibility for premium tax credits. I submitted the information, but kept getting more notices to send information. Now 90 days have passed and my tax credit has been reduced. What should I do?

You can appeal the Marketplace’s decision to reduce your tax credit.  Information on how to appeal will be included on the final determination notice.  If your appeal is successful, your tax credit will be restored retroactively.

If I use my premium subsidy for a Bronze plan, I can save even more money on the premium. Can I get also get my cost-sharing reduction through a Bronze plan?

No, you can only get cost-sharing reductions by enrolling in a Silver Marketplace plan. You will not receive cost-sharing reductions if you enroll in a Bronze, Gold, or Platinum plan. Note that this is different from the rule for premium tax credits. You can apply premium tax credits to all four types of plan. However, if you are eligible for both kinds of help (that is, if your income is between 100% and 250% of the federal poverty level), you can only receive both types of subsidies if you enroll in a Silver plan.

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

The answer depends on whether you are receiving advanced premium tax credits. For people receiving advanced premium tax credits, if a payment due date is missed, insurers must provide a 90-day grace period during which consumers can bring their premium payments up to date and avoid having their coverage terminated. However, the grace period only applies if an individual has paid at least one month’s premium.

If, by the end of the 90-day grace period, the amount owed for all outstanding premium payments is not paid in full, the insurer can terminate coverage.

In addition, 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, which means the enrollee may be responsible to cover any health care services they receive during the second and third months if they fail to catch up on the amounts they owe before the end of the grace period. Insurers are supposed to inform health care providers when someone’s claims are being held. This could mean that providers will not provide care until the premiums are paid up so that they know they will be paid. People not receiving advanced premium tax credits are expected to get a much shorter grace period; currently, the general practice is 31 days but it may vary in each state.

Whether or not you are receiving premium tax credits, if you have coverage terminated for non-payment, this could affect your ability to buy coverage from that health insurer in the future.  Insurers are allowed to require people who owe back-due premiums from the past 12 months to repay the premium debt before they will renew or sell you new coverage for the year.

States can prohibit or limit this practice by insurers.  Contact the Marketplace and your state insurance regulator for more information.

Can a third party pay my portion of the monthly health insurance premium for me?

Possibly.  Federal rules require health plans offered through the Marketplace to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other Federal and State government programs that provide premium and cost-sharing support for specific individuals, and Indian tribes and tribal organizations.  Federal rules discourage Marketplace plans from accepting third-party payments from hospitals, other healthcare providers, and other commercial entities.  Check with your health plan for more information.

Finally, if you are a patient with end-stage renal disease undergoing kidney dialysis, you are eligible to enroll in Medicare.  However, some dialysis facilities have offered to pay premiums for patients who elect Marketplace coverage instead of Medicare.  If a dialysis facilities offers to pay your Marketplace premium, directly or through a charity, it is required to first check with the Marketplace insurer to verify that it will accept this third party payment.  In addition, the dialysis facility must disclose other important information to you, including about the potential for gaps in coverage and penalties if Medicare enrollment is delayed.  Dialysis patients should contact a Marketplace navigator program or your state’s Senior Health Insurance Assistance Program, which provides information, counseling, and enrollment assistance for people eligible for Medicare.

Can I pay my health insurance premium with a credit card, debit card, money order, or cash?

At least within the individual-market Marketplace, insurers are required to accept money orders and pre-paid debit cards. They do not have to accept credit card or debit card payments unless states make that a requirement, although many insurers currently accept all of these forms of payment. Therefore, it may vary from state to state and between insurers.

I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?

No. Insurers offering coverage in the individual-market exchange or Marketplace are required to provide a variety of payment methods and cannot require a consumer to pay by automatic bank withdrawals (sometimes called electronic funds transfers, or EFT.) Federal rules require the insurer to accept paper checks, cashier’s checks, money orders, and all general-purpose pre-paid debit cards, as well as EFT. These methods must be available to consumers for both the initial premium payment (at enrollment) and ongoing payments.

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

No, in most states 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 if you have qualified to receive an advanced premium tax credit, the government will pay the credit directly to your insurer and you will pay the remainder of the premium directly to the insurer.

I’m 59, my spouse is 55, and our kids are 24, 17, 15, and 13. What age premium will we be charged for health insurance in the Marketplace?

Family premiums will reflect the composition of family members, their ages and their tobacco use. To compute a “family premium,” insurers will add together a separate premium for each adult age 21 and older. In addition, insurers can charge a separate premium for up to three children under age 21. In your example, your family premium will reflect three adult premiums and three child premiums.

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