What are my options as far as not paying for the months I didn’t have coverage?




***Pretty much none.  If you don’t pay, you won’t be able to get coverage till next Open Enrollment as you haven’t mentioned anything that would qualify you for special enrollment.  Check out our page on temporary plans to tide you over till then.


My payments [subsidy – APTC Advance Premium Tax Credit] changed this year because my income is less than last year.

***Next time try the complementary agent support and have someone experienced like us help you with these problems and hopefully let you know in January.   We only get paid if you appoint us.   Did Covered CA or Health Net give you an explanation as detailed as this page, without waiting on hold?


I’ve been told by Covered CA I will probably be reinstated but I will have to back pay for the months I didn’t have coverage (Feb., March, April, May, and maybe June).

***As soon as you prove that your payment was $208, you did have coverage.   Can Health Net prove they sent you a cancellation Notice in January?

45 CFR 156.270  (d) Grace period for recipients of advance payments of the premium tax credit. A QHP issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month’s premium during the benefit year.




If I don’t have coverage are there any other problems besides the  fee [Mandate Penalty 2.5% of Income] at the end of the year for not having health insurance for those months..

***Are you OK with paying bills out of future earnings or losing your home and assets and bankruptcy if you have a large unexpected medical problem?

Scroll down for more FAQ’s or to ask a question.



Resources & Links


If you want to file and appeal – as you think you were  mislead and get a new special enrollment period – click here for our appeals page.

See our page on – was the cancellation legal?

#Appeal Guide 
DOI Washington State

how to appeal health care insurance decesion


Navigating the Appeals Process -

Patient Advocate Foundation 

Navigating the Appeals Process


Kantor & Kantor Attorneys

Right to Appeal - if claim denied

You Tube Videos


CA #SmallClaims Court Guide 56 Pages
Gathering the documents you need
CA Small Claims Court Guide


Department of Consumer Affairs - Mediation Request ONLINE

mediation request

How Mediation Works & Paper Mediation Request Form

engage mediation.com


Appeals?  Grievances?

Check the FULL policy, EOC - Evidence of Coverage here's a specimen and see what the rules are on cancellation and notice.

Then if you do decide to do an appeal, (page 151 in specimen policy) or view our webpage  on appeals, you'll  know what to argue about.

12 comments on “Paying Back Premiums to get reinstated?

  1. i had coverage starting in January.

    i had a change in income, applied for new coverage and received special enrollment in May.

    January, Feb paid with zero balance,

    March premium paid on April 13

    and new policy starting may 1, first month premium paid on April 20. April remained unpaid.

    i contacted Blue cross to make payment for April and June on June 8th and was informed i was cancelled for non payment as of APril 1st.

    • Where you getting subsidies on the policy you got in May? See 45 CFR 156.270 (d) above. Did you cite any law in your appeal? Did you provide proof of payment?

  2. Is there and advocate for Pennsylvania that can assist me with my coverage being cancelled for non payment?

    i have filed appeals with BLue Cross and been denied for reinstatement.

    i have filed appeal with Pennsylvania Department of Insurance and been denied for reinstatement.

    i have filed a complaint with Better Business Bureau and have had my case closed unanswered.

    i am in the process of filing appeal with the Markeptlace.

  3. I found a form online to request a hearing. The form is called “Request for a State Fair Hearing to Appeal a
    Covered California Eligibility Determination”.
    Here’s a link to the form:

    I called the number on the form. (1-855-795-0634) I was able to submit an appeal over the phone instead of having to send in the hearing request form.

    I will let you know how it all turns out.

  4. Are you sure it was Department of social services or do you mean Department of managed healthcare or department of insurance I don’t see that department of social services has anything to do with it

    I don’t know of any law or precedent to allow you to start July 1 if you have that please post it here because it will teach me something new would be helpful to other site visitors

    When you say take it to a judge do you mean go to small claims court superior court or in and made a straight of law judge in the appeal section of covered California or Department of insurance I’m using my iPhone now so I can’t put in all the links that I’d like to but if you search for appeals on this website you can find everything that I have but don’t forget you’ve got to show all the proofs and you’re going to have to show that you were never properly canceled and have proof I’m not an attorney so please doublecheck everything that’s not cited

    • I guess you’re right because Medi-Cal is part of the department of public social services

      also if you can show a material violation or error then that would get you new enrollment.

      So your policy would be not reinstated it would be a brand-new special moment.

      Any be able to pick any plan and then you can appoint a says your age and we can get it going for you and that way we get paid for helping you rather than just is a public service

      In the menu above put your mouse over special enrollment and then look for material violation

  5. Hi Steve,
    Thank for responding back to me. Today I called CA Department of Social Services and submitted an appeal for being wrongfully cancelled and asked that I be reinstated starting July 1st. Since I will be reinstated July 1st, i will not have to back pay for the months I did not have coverage. The back pay is more than the federal fee for not having health insurance. I will gladly pay the federal fee.

    If for some reason, Covered CA and Healthnet can not resolve this issue I will have to present my case to a judge and he will decide.

    Thanks again for your time and all the great resources you have provided me.


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