Transition from regular coverage to ACA

[larry]

The facts;

Called insurance company that I had regular (non-ACA) coverage with in mid November and switched to ACA plan (with the same company) for 2018. Paid January 2018 ACA coverage at that time. Also, the rep noted that she would cancel coverage at the end of December 2017.

Received notice from company that December billing (ACH event) was delayed and would receive notification later.

Doctor visits in December were not covered as when bills were submitted they were denied for lack of coverage. Evidently our insurance was cancelled at end of November instead of December.

Now at this point I am not arguing that they should cover the bills as the bills were way cheaper than the premium payment.

January rolls around and I receive past due amount for 2017 December bill.

My initial thoughts are this, if there would have been a life changing insurance event in December the insurance company would have argued that I cancelled my insurance and not paid any of the bills but now after the fact they would claim it was cancelled in error and that I owe a past due amount.


Thoughts?

 

[Tallman4123]

Health insurance is a month-to-month proposition, so if you don't pay your December premium, they'll eventually just cancel your policy effective the end of November (although you believe they already mistakenly did this). I don't think you need to call and make any argument about it.

My two concerns otherwise would be:
1. Are they somehow going to conflate your former policy and your new ACA policy and cancel your ACA policy? They shouldn't, but they are clearly already confused, so it's certainly possible.
2. For tax year 2017, you will owe a shared responsibility payment under the ACA which is will be 1/12th of either 2.5% of your household income or $695 per covered person, whichever is greater (there an upper limit to the 2.5% penalty based on the price of a Bronze plan).

Ultimately, in trying to keep life simple, some people might argue that since you fully intended to make the December premium payment, go ahead and do that and have the December claims resubmitted for payment. I don't know if that's necessarily easier, but it's certainly more consistent with your original intent.

 

[MBSC]

2. For tax year 2017, you will owe a shared responsibility payment under the ACA which is will be 1/12th of either 2.5% of your household income or $695 per covered person, whichever is greater (there an upper limit to the 2.5% penalty based on the price of a Bronze plan).

A person can go two calendar months without ACA compliant coverage without penalty.

If you lacked health coverage for no more than 2 continuous months, you qualify for a health coverage exemption.

You’re considered covered any month you had minimum essential coverage for even 1 day. Example: You didn’t have coverage from March 2 to June 15. Your coverage gap was 2 months – April and May. You qualify for the exemption.

If your gap was 3 months or more, you can’t claim this exemption for any of those months. Example: You didn’t have coverage any day in April, May, or June. You can’t claim this exemption for any of those months.

Reference: https://www.healthcare.gov/exemptions-tool/#/results/2015/details/short-gap

 

[larry]

Sorry guys, carried 2017 insurance off the ACA market, wasn't real clear about that.

 

[athena53]

My initial thoughts are this, if there would have been a life changing insurance event in December the insurance company would have argued that I cancelled my insurance and not paid any of the bills but now after the fact they would claim it was cancelled in error and that I owe a past due amount.


Thoughts?

Since there's no penalty for a one-month gap in coverage I'd be tempted to ignore their request for payment. I'm surprised they didn't notify you of the "cancellation", though. Most states have laws requiring this to make SURE the consumer knows that the policy is being cancelled and has a chance to pay up. This company didn't process your payment and then appears to have cancelled without telling you; you found out only when your claims were denied.

I'm still getting requests to pay the premium for coverage that was supposed to start on 1/1 via healthcare.gov. I was eligible for Medicare on 1/1 and obtained all the necessary coverages but since I didn't select a new policy for 2018 on healthcare.gov it chose one for me forwarded my info to the insurer (Cigna) and I've gotten multiple bills for the January premium. No cancellation notice yet.

 

[Tallman4123]

Sorry guys, carried 2017 insurance off the ACA market, wasn't real clear about that.

Yes, I understood that. And MBSC is correct; I forgot about the "short gap" exemption.

 

[N02L84ER]

If the December medical bills were paid at negotiated insurance rates and you did not pay for the insurance, those medical bills may go higher.