If you lose your Advanced Premium Tax Credits (APTC) be careful,
One Can lose ALL Coverage for just missing ONE month Premium!


Excerpt of email blast from one or our carriers:

We are aware that some of our members lost their subsidy and now owe a full month of premium payment(s).  Some were able to supply proof needed by the exchange and had their subsidy reinstated, however there is a month or more gap where the government subsidy lapsed, therefore the member is responsible for the full premium during that time.   We sympathize and understand that most of our members cannot afford to pay a full month and are therefore skipping that month and trying to pay the following month.

We are receiving a lot of questions asking:

“If the client does not pay the month(s) without subsidy and they pay the following month with subsidy will they be able to use the insurance?”

Unfortunately, the answer is No, they will not.  Members must pay their responsible portion of the premium or the policy will lapse. For example:

Month of May Member’s responsibility after applying the subsidy is $22.50 (member sends in $22.50)

Month of June Member’s responsibility is the full Premium after subsidy lost is $550.00 (member did not pay)

Month of July Member’s responsibility after applying the reinstated Subsidy $22.50 (Member sends in $22.50)

In the example noted above, since the member did not pay for the month of June, the $22.50 will be applied to the June premium of $550.00 leaving a balance of $537.50 owed for month of June, and $22.50 still owed for July which will bring it back up to a balance due of $550.00.  If the whole balance is not paid, the member will be suspended and will have no coverage until account is brought to current status.

After 90 days the client will be terminated for non-payment, and, unless they have an SEP – Special Enrollment Period, cannot enroll again until open enrollment starting in November and no coverage till January 2016.  Molina will not send the member to collections for the owed amount however; they will still owe that until paid in full.

The member always has the right to file an appeal to the Exchange.  They would need to submit a letter or an Appeal Request form to:

Health Insurance Marketplace Attn. Appeals

Department of Health & Human Resources

465 Industrial Blvd, London, KY 40750-0061

The following information MUST be in the uppers corner on EVERY page, If not on a page it will NOT be considered as received:  First and last name, SSN# and State.

Successful eligibility appeal results will be communicated to the Issuer via a HICS case.

Thank you for your inquiry and hope this information helps in the future. As always if you have any questions please feel free to give us a call.

Related pages in Grace Periods? NEVER get cancelled Non-Pay!!!

Special Enrollment – Change in Enhanced SilverIncome §D 6?


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