What Do I Do When Coverage Lapses Accidentally?
My husband and I had a good plan through Obama care and then unbeknownst to me, when our furnace went out, he missed several payments and we were canceled. I didn’t find that out until open enrollment was closed. I have called several numbers and there’s a message that says they will call back to help, and they never do. I desperately need coverage. I have several health problems that need to be addressed ASAP.
Any help you can give me, even if it’s just for me to be covered, would be greatly appreciated.
Answer
If coverage ends due to non-payment you don't qualify for special enrollment and can't get a plan until next open enrollment. That doesn't mean you have no options though you can still:
- Contact your insurer and ask them to reinstate the plan. You should have a window of opportunity to make good on payments before they care canceled. At least 30 days is required under law before coverage can be canceled.
- Qualify for one of the many other qualify life events that trigger special enrollment.
- Qualify for Medicaid and CHIP based on MAGI income.
- Get short term health insurance to protect your health (doesn't protect you from the fee).
- Get coverage through an employer who offers coverage (can be a 90 day waiting period).
- See other options for those who missed the deadline (most of these apply to those who lose coverage mid year).
- Look into exemptions from the fee.
- Appeal any decisions you don't agree with.
This seems frustrating, but the rules are in place to ensure people don't wait until they need care to get coverage or switch plans. Still for those who honestly let coverage lapse by accident the rule really its counter productive to ensuring all Americans are covered and essentially works as a handout to the insurers allowing insurers to collect a few premiums and then drop folks before they have to cover anything. Certainly a more elegant solution is needed.
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I am in this situation after believing I had made payments. I made them online and did not see a very small, little box that had to be checked for the bank transfer to go through. I was given no notice that I was late in paying. I discovered it when I went to fill a prescription. I would gladly pay those premiums I thought I had paid (get myself up to date) and even a penalty (that would be unfair but I’d be willing) to get my coverage back. I can understand that I should pay for a whole year even if I don’t use it. But to not be able to get insurance is insane and defeatist. In fairness, I have initiated the appeal with my insurer and it’s possible I’ll be reinstated but the situation remains absurd and counterproductive to the ACA’s intentions.
Highmark BC/BC said my family’s coverage is cancelled retroactively to January 1, 2016. Reason used is non-payment, however, I have a very strong disagreement related to their reasoning…it is based on a very aggregious series of billing errors by them and repeated cancellations dating back to September 2015 and still not resolved as of May 2016. I need the help of the law to make them correct the self-admitted errors that were repeatedly made within their computers or systems, and that were put upon my family as a serious and costly burden.
Got it. So in a case like this, if you have been making calls to them and trying to sort it out, they will typically re-instate on their own accord. If this fails then you’ll need to appeal to them directly. Everyone has the right appeal under the ACA, and to be clear, no people did not have the same rights before the ACA.
My health insurance’s not sending me bills since I joined the plan in Jan 2016. Every month I had to call to make the payment and ask them to please send me a bill. Each person I talked to said they would correct the mistake. Month after month I called until I completely, in error, did not make one payment in April. I was out of the country. It comes time to pay May and when I again, had to call to make the payment I was told I was dropped from non-payment of April. I was in shock! No warning letter, nothing. When I made the appeal they sent me copies of the letters that were supposedly sent out. I never received any of these. EVER! The market place looked into it and said I was dropped because of “lack of payment:. Period. I never received any written correspondence from Blue Cross, aside from my id card, EVER! I am now without medical insurance for my family and am ever frustrated at this process. Only black and white, no grey is evert taken into consideration. Can you help me, Please??!
The last I knew I was covered by medicaid. I missed the open enrollment at my job because I thought I was covered. Then I got really sick… I went to the Dr and apparently my medicaid had been terminated at the end of January 2016 So now I can’t enroll at my work or medicaid. I make to much Medicaid said. So i am without when I need it the most. The ones working and trying to do something with their life should receive some type of something to help a situation like mine out. But no. The people who live off welfare get all the help they need. And half don’t file taxes. And if they do its just to claim kids to get back a large sum of wasted money. That’s anot her topic though. What can I do to get covered temporarily. ?
My husband worked as a contractor for a recruiting company for the last 3 months of 2017, and January 2018. He signed up for health insurance, and they deducted the premiums from his paycheck. Then in January, he submitted a claim, and was told he did not have coverage. He was hired as a full time employee in February, no longer a contractor, and signed up for health insurance with that company, so now he has coverage. So he from Oct 2017 through Jan 2018 he did not have coverage, but he believed he did. The contracting company paid him back the premiums they took out of his paycheck, but now he is facing having to pay the penalty. He also had a 30 day gap earlier in 2017, when he was in between insurances with another company, so this would be the second gap. Is there an exemption from the penalty since he thought he was covered? How can we document this?
I would contact healthcare.gov on this one. You might be able to claim an exemption using form 8965 due to the confusion. But the way it would be documented is probably something healthcare.gov would need to coordinate with you.
This is somewhat uncertainty territory, but there is potential of qualifying for an exemption none-the-less. With these things, the sooner you act the better!
Hope that helps.