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Past-due premiums, missing tax forms may hamstring marketplace customers

Michelle Andrews, Kaiser Health News on

Published in Health & Fitness

The 2018 annual open-enrollment period for coverage on the health insurance marketplaces started November 1. But if you don't take care of lingering issues from your past coverage, they may come back to haunt you when you try to sign up this fall.

UNPAID PREMIUMS

New rules will allow some insurers to require you to pay any back premiums you owe for the 12 months prior to the effective date of your new coverage.

The rule, which became effective in June, generally applies only if you try to enroll in a plan with the same insurer, not if you choose coverage from another company. It's up to insurers to decide whether to come after you for the money.

But there may be only one insurer offering coverage in many areas. In those cases, if you've fallen behind on payments, "you really won't be able to escape this policy," said Tara Straw, a senior health policy analyst at the Center on Budget and Policy Priorities, a research and policy institute in Washington, D.C.

Insurers have to notify you before you miss premium payments if they plan to implement the rule.

The Affordable Care Act offers some protection for people who fall behind on their payments. Under the law, you have a 90-day grace period in which to catch up on unpaid premiums. Once that grace period ends, your coverage would be canceled retroactive to the end of the first month of delinquency and you'll be responsible only for your portion of the first month's unpaid premium. (You wouldn't be responsible for premium tax credits paid by the government on your behalf to the insurer.)

But if you stop paying your premiums during the last three months of this year, you could get hit with a bill for a full three months of premiums if you re-enroll for 2018 coverage. This is because your 90-day grace period hasn't ended.

"Effectively your coverage has never terminated, and therefore you owe for the full period," said Timothy Jost, an emeritus professor of law at Washington and Lee University in Virginia who specializes in health law.

If you want to drop a marketplace plan, it's not enough to just stop paying premiums.

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