Employer-sponsored major medical coverage goes away when you stop working for your employer, but individual health plans aren’t tied to your job status. This gives you the freedom to switch career tracks without affecting your healthcare coverage. But even with an individual health plan, continuous coverage isn’t always a sure thing. There are a variety of circumstances – some that you can control and some that you can’t – that could cause you to lose your non-group health insurance in 2019.
You Will Lose Coverage If You Don’t Pay Your Premiums
To maintain healthcare coverage, you must pay the monthly premiums. If you don’t pay, you’ll lose your health plan eventually.
Even if you qualify for Affordable Care Act subsidies, you may be responsible for remitting a premium payment each month. The tax credits for which you qualify will probably cover only a portion of your major medical premiums. It’s your responsibility to submit the remaining balance to your insurance company before the due date each month.
However, you won’t automatically lose your coverage just because your payment is a few days late. The federal government requires that insurers provide a grace period to Obamacare subscribers. After missing a payment, you’ll have a 90-day period to make up past-due payments and submit any additional premiums due in the meantime.
For example, if you miss your August 1 due date, you must turn in your payments for August, September and October by the end of October to maintain your ACA 2019 coverage. If you don’t catch up on your payments by the deadline, your plan will be terminated. The cancellation will be retroactive to the date of your first missed payment – in this case, August 1. That means any claims submitted during that time won’t go through, and you could also be stuck with unexpected medical bills since you weren’t covered during that period.
Grace periods are allowed only if you begin the year by making at least one month’s payment. If you miss the first due date of the year, you might not receive any grace period. Also, the federal rule about grace periods is specific to those who are eligible for advance premium tax credits. For those who don’t receive subsidies, different rules may apply, and these may vary among states.
Losing your major medical insurance because you failed to turn in your premium payments means that you won’t be eligible to sign up for a new major medical plan until the next open enrollment period. Nonpayment doesn’t qualify you for a special enrollment period, so you’ll probably have to go without major medical insurance for a time.
Even open enrollment doesn’t wipe the slate entirely clean. If you select a plan from the same insurer that you had before, you may be required to make up payments from the previous year before the company will agree to issue you a new plan.
When you enroll in your Obamacare 2019 plan, think carefully about whether you’ll be able to pay the premiums from month to month. It’s better to have a high deductible plan with lower, affordable premiums than it is to be left with no coverage at all because you couldn’t make the premium payments on a higher-tiered plan.
You Might Lose Coverage If You Fail to Act
There are times when a healthcare marketplace application requires more information than what you originally provided. After submitting your application, you’ll receive a notice if there is additional information that you must turn in. The request will be accompanied by a deadline for submitting the information.
Most special enrollment periods require that you turn in proof of your eligibility. You’ll be given 30 days to provide the necessary documents.
Failing to turn in the required documentation is grounds for losing your health insurance. If your plan is terminated for this reason, you won’t be eligible for a different one until the next open enrollment period.
You Could Lose Coverage If Life Circumstances Change
Life changes fast, doesn’t it? When it does, you could lose your major medical plan. During stressful times, health insurance might be the furthest thing from your mind, but it’s important to pay attention to whether your coverage will still be valid. Unlike failing to pay or to send in documentation, life circumstances are sometimes beyond your control. If you lose your major medical health insurance for one of these reasons, you may be eligible to purchase a new plan from the healthcare marketplace right away.
Going through a divorce can alter many aspects of your life, including your health insurance coverage. If your major medical plan is in your spouse’s name, he or she will have to remove you from the plan once your divorce is finalized. Filing for a legal separation can also cause you to lose your health insurance. It’s the subscriber’s responsibility to update the marketplace application with a change in marital status.
Insurance options vary throughout the country, and most insurers have a specific service area in which they operate. If you move out of that service area, you could lose your healthcare coverage. A move across state lines will certainly terminate your current plan. An in-state move is less likely to require that you find new health insurance, but there’s still a chance that you won’t be able to keep your coverage after the move.
Even if you don’t think that moving will cause you to lose your medical coverage, you should notify your insurer of your change of address. If you have an Obamacare plan, you’re required to submit this information to the marketplace. For an in-state move, you do this by updating your current ACA 2019 application. For an out-of-state move, you must start a new application.
ACA regulations allow young adults to stay on their parents’ major medical coverage until they turn 26. Even if you have your own house, you’re married, you’re financially independent or you could get insurance through your workplace, your parents can allow you to stay on their plan until you age out at 26
Exactly when you lose health insurance after turning 26 depends on the type of plan that you have. This is one area in which those on nongroup health plans have an advantage over those with employer-sponsored health insurance. Job-based insurance plans typically terminate coverage the day that a dependent turns 26. Plans through the healthcare marketplace allow dependents to keep their coverage until the end of the calendar year in which the 26th birthday occurs.
You’ll Lose Coverage If Your Insurer Stops Offering the Plan
There’s always a chance that your insurance company will experience a major change. The company might suddenly quit offering your plan. It could even go out of business. If that happens, you’ll no longer have major medical coverage. Fortunately, since this is a circumstance outside of your control, you won’t be held responsible for this loss of coverage. You’ll qualify for a special enrollment period so that you can sign up for a new health insurance plan right away.
The Affordable Care Act guarantees your right to coverage no matter your health history, and insurers can’t drop your health plan for arbitrary reasons or because you develop an expensive medical condition. But these guarantees don’t extend to situations like major life changes, nonpayment or an insurer going out of business. If you find yourself without a health plan for legitimate reasons – like something outlined above – consider your other options for health insurance, whether it’s a major medical plan outside of the marketplace or a short term policy to bridge a gap in coverage.