Failure to pay the premium may result in a loss of coverage, but there is a grace period (usually 3 months with a tax credit). Do not pay all premiums due during this period. It depends on whether you are receiving early tax credits for premiums. If you receive a tax credit for premiums and are looking for Home Care near Aliso Viejo CA, your insurer must grant you a 90-day grace period to pay all overdue premiums. If the amount due for all outstanding premium payments isn't paid in full by the end of the grace period, the insurer may cancel the coverage. Failure to pay the premium may result in a loss of coverage, but there is a grace period (usually 3 months with a tax credit). Do not pay all premiums due during this period. It depends on whether you are receiving early tax credits for premiums. If you receive a tax credit for premiums and are looking for Home Care near Aliso Viejo CA, your insurer must grant you a 90-day grace period to pay all overdue premiums. If the amount due for all outstanding premium payments isn't paid in full by the end of the grace period, the insurer may cancel the coverage.
However, the grace period only applies if you have paid at least one month's premium within the current plan year. On August 22, 2025, a federal judge in Maryland issued a court order that temporarily suspended the implementation of seven provisions of the new market rule. See new laws and policies for more information. The following resource describes the provisions of the regulation without regard to the court order.
Members who don't pay their premium by the assigned due date have a grace period before their coverage is canceled. The grace period is different for members who receive an Advance Premium Tax Credit (APTC) and for those who don't. Registrants who receive an APTC have a period of grace for three months. Those who don't receive an APTC have a grace period established by state laws or regulations (generally 30 or 31 days, or left to the insurer's discretion).
In some cases, a person who receives an APTC may have a grace period that spans two years of the plan. For example, a person who doesn't pay their November premium will receive a grace period that extends for three months to the end of January of the following year (coinciding with the next open enrollment period and year of coverage). If the member automatically re-enrolls or actively selects a new plan for the next year of coverage during the open enrollment period, the insurer must accept the enrollment, unless it requires payment of overdue premiums for new coverage (an option available to insurers starting August 25, 2020). Unless otherwise required by state law, insurers in states served by the FFM have the option of adopting a premium payment threshold policy. The FFM recommends a threshold of 95 percent of the premium or higher, meaning that if an affiliate sends at least 95 percent of what they owe, they won't be considered overdue.
Some insurers may consider that the first month's premium is fully paid as long as it exceeds the designated payment threshold. For people who qualify for these SEPs, insurers must set the deadline for paying the first month's premium at least 30 days after selecting the plan. A person who is eligible to apply for the APTC but decides to wait and apply for the premium tax credit when filing their tax return will only be entitled to a grace period established by state laws or regulations, which is generally 30 or 31 days or left to the discretion of the insurance company. If this happens, providers may ask you to pay the full cost of care out of pocket, or they may not provide care until the premiums are paid.
This also means that if a person with overdue premiums actively selects a new plan and pays the January premium for a new year of coverage, the insurer can apply this payment to an overdue premium and require an additional payment to make the new year's coverage effective. However, if a person who previously enrolled in a QHP automatically re-enrolls in a health plan from a different insurer than they had the previous year, or actively enrolls in the same or a different plan, they will have to pay the premium for the first month of the new plan for coverage to begin. The following frequently asked questions explain market policies on premium payments, grace periods for people who don't pay premiums on time, and the termination of coverage for not paying premium amounts due at the end of a grace period. For coverage to begin retroactively, a person must additionally pay premiums for all months of retroactive coverage before this deadline. This is true even if the member pays a premium for the new year of coverage (for example, for January), since the insurer can apply this payment to any overdue amount owed by months of grace period.
