The New 90-Day Major Medical Grace Period

[FLM2]

September 11, 2014

Well what do you know...word is getting around. Got a call from one of my off-exchange Colored Company clients today who is paid up to 8/31/14. She is going to get her +$75,000 double knee surgery this month, during month 1 of her grace period, where all medical claims have to be paid. Says the 8/31/14 premium payment is the last one she'll make this year. Going on Medicaid for OCT/NOV/DEC. ACA again on 1/1/2015.

-ac

That one month's premium doesn't make any difference to the insurance company, they would have been on the hook for the whole claim regardless. So, if she would have paid the September premium, had the surgery, and then dropped the plan for Medicaid you would have been OK with that?

I have a couple of clients who did that this year-my response is to take them off my client list and, if they call me again, to not return the phone call.

 

[AllenChicago]

She is in for a rude awakening. You said it's an off-exchange client. The 90 day grace period applies only to ON-exchange and only to those getting a subsidy. Yes, for subsidized plans, the first 30 days of lapse allows them to still have their claims paid by the insurance company. However, for OFF-exchange, and non-subsidized on-exchange plans, the 30 day grace period works like it did before, where the premium must be received within those 30 days or else the policy lapses all the way back to the paid-to-date.

ANN..THANK YOU!!! I'll let her know that she better get that September premium in ASAP!