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Affordable Care Act: Once You’ve Applied

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After you submit your application and you’ve had the opportunity to compare plans that are appropriate for you, you make your choice. Be certain that, before you do, you’ve found answers to all your questions about the new plan, such as “Can I still use my current doctor?” and “Will I be covered when I travel?”

If the SBC for the plan doesn’t spell out all the answers you need, ask for help from a Marketplace customer service representative, who can help you find what you need.

Selecting a plan

What happens if you choose your plan and go through the enrollment process, and then you decide you want to switch to another coverage option? It depends. If you change your mind immediately — before your coverage begins — and you’re still within an enrollment period (either open or special enrollment), you should be able to make the change by revisiting the Marketplace.

However, if your coverage has already started when you change your mind, you must wait until the next open enrollment period to make a change (unless you experience a qualifying event before that, in which case you can change during a special enrollment period).

Enrolling

You enroll by selecting the plan you want to purchase and making arrangements to pay for it. This step is fairly quick and easy.

If you qualify for tax credits that help offset your premium costs, after you enroll, you can have those credits sent directly to the insurance company to reduce the premium you owe. You then arrange to pay the premium in a way that’s the most convenient to you, whether online or by mail.

Note that you make your premium payments to the insurance company itself, not to the Marketplace in your state. After you enroll, you’re directed to the insurer’s own website to make your first payment. Under the ACA, insurers must work with various forms of payment (including paper checks and money orders); you cannot be forced to have a credit card or bank account.

You need to send in your first payment so it’s processed at least a day before your coverage is set to start. Before you enroll, you’ll know the premium due dates for that plan so you can anticipate when your first and subsequent payments are needed. If you cannot locate this information or you have any doubts about it, be sure to ask a Marketplace customer service representative for assistance.

After you’ve paid your first month’s premium, if you’re getting tax credits to help pay for your coverage, your insurer must grant you a 90-day grace period if you’re late with a subsequent premium payment. You must get current with your premium payments within those 90 days to avoid having your coverage canceled.

Thirty days into that grace period, the insurer has the right to withhold payment for any new claims. That means if your policy is terminated because you don’t pay your premiums in full, you’re on the hook for services you used in the final two months of the grace period. (The grace period for people who don’t receive tax credit assistance is generally much shorter.)

The bottom line is this: Before you enroll, make sure you’re committed to making your premium payments on time. Otherwise, you may be digging yourself a financial hole and jeopardizing your ability to maintain coverage and comply with the ACA.

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