The Marketplace has rules in place that may give consumers who have outstanding premium payments due for their Qualified Health Plan (QHP) insurance a short period of extra time to pay after the payment due date has passed before the insurance company can take away their coverage. This short period of time is called a “grace period” and it varies depending on whether a consumer is receiving advanced premium tax credits (APTC) or not.
Under current rules, QHP issuers must:
- Allow consumers who receive APTC a three-month grace period if they have paid at least one full month’s premium during the benefit year (See 45 CFR 156.270(d)).
- Grant consumers who do not receive APTC a grace period in accordance with state rules (See 45 CFR 155.430(d)(5)). Assisters may want to contact their state department of insurance (DOI) for more information on grace periods based on state rules.
CMS has issued additional guidance to issuers related to how grace periods should be applied to consumers in various situations. Assisters should look for an upcoming fact sheet with more details about grace periods in the near future.