Do I need to mind the gap?

February 24, 2014 10:31 AM

Now that I'm on a group health insurance plan, do I have to pay the last month's premium for my individual plan or can I leave a gap in coverage?

I just got a new job and am now enrolled in their group health insurance plan. Yay! Prior to starting this new job, after losing my grad school insurance last August, I signed up for an individual plan and then switched to another ACA-approved individual plan on January 1st. Because of an accounting slowdown related to ACA signups and the way that the billing dates fall, I haven’t yet paid my premium for the current month of my individual plan. Do I have to pay this premium?

In the past, I would have been worried about having a gap in between periods of coverage because I have a pre-existing condition, but as far as I understand it, now, because of the ACA, I don’t have to worry about that? The Schedule of Benefits for my new group plan clearly states that it has no pre-existing condition limitations (see p. 23 here).

So, do I have to pay this premium? Is there something I don’t know or am not thinking about here? (I don’t have a lot of experience in this area, it it's not clear!). If not paying the premium could cause problems with my coverage in the future, I’ll do so, but if not, I have things I’d rather do with the money than give it to my insurance company (I realize there are ethical reasons why one might pay even if not required to, but I'm not interested in answers about those, thanks).

posted by raisindebt to Work & Money (4 answers total)

If you were actually covered(if you went to the hospital yesterday would your insurance company have covered you?) then yes, you probably do still owe them money, and they will probably send the bill to collections etc eventually, which you do not want. It also may take a few weeks for your new insurance to kick in.
posted by rockindata at 10:38 AM on February 24, 2014

Even in a pre-ACA world, you had some grace period wherein a gap in coverage would not count against you for purposes of pre-existing conditions (for circumstances like a job giving new employees a 90-day probation before eligibility for insurance). If you old insurance company is OK with you not paying and them not covering you for that month, I say don't pay, but, like rockindata says, if you are going to get dunned for it, might as well pay it and get it over with.
posted by Rock Steady at 10:51 AM on February 24, 2014

Are you asking if you can avoid paying for coverage you received (even if you didn't use that coverage) because you switched plans and thus don't care if that insurance company gets mad at you? Or am I misunderstanding the question? If I'm not misunderstanding, the answer is: yes, you have to pay for a service you receive even if you don't intend to deal with the provider of that service in the future.
posted by Justinian at 3:13 PM on February 24, 2014

Did you use any services? If you used your health insurance, I think you need to pay for the month so you don't get billed the full cost of your doctor's visit/prescription/whatever. If you didn't, no, don't pay it. They will just cancel your coverage for non-payment.

I just did that. I had insurance on my own through Cobra and then I got a new job, so I just didn't pay the last month and my coverage was automatically terminated. For my new plan, I need to prove I had coverage within 60 days of starting the new plan so my pre-existing condition can be covered. I called my former insurance and got a certificate of coverage to send to my new insurance company.

I'm not clear on what ACA does for pre-existing conditions, but it sounds like you should be well within the timeframe necessary anyway. Check on your plan, but last time I switched insurance a couple years ago, the timeframe was very long, like 6 months to a year that I had to have my pre-existing condition covered. This one is pretty short at 60 days, but I'm still within it. So even without ACA, I think you're fine.
posted by AppleTurnover at 6:49 PM on February 24, 2014