Insurers worry ACA loophole could lead to unpaid premiums, bad debt


Thanks to a loophole in the Affordable Care Act regulations, insurers worry customers who purchased plans on the federal marketplace could evade paying their December premiums, reports Vox.

On July 16, the Center for Consumer Information and Insurance Oversight and the Centers for Medicare & Medicaid Services finalized a series of regulations meant to establish consumers' rights to shop for healthcare plans. Yet the rulings may allow consumers to forgo paying their premiums.

Under ACA law, consumers can go 90 days without paying their premiums and not lose coverage, FierceHealthPayer previously reported. Because coverage stops on the last day of the first month of the grace period, if an individual does not pay for the three months, it's possible he or should could get coverage through that entire first month, notes Vox.

Come December, it's possible more consumers can find ways around paying for their plans. Under federal regulations, payments made by an individual who re-enrolls in a new insurance plan do not automatically pay for outstanding debt on an old, 2014 plan.

Hypothetically, an individual could refuse to pay for their plan this December and then rejoin their plan next year. Meaning, their new health plan cannot pay for their old, unpaid one, according to Vox.

To ensure timely payment, insurers are urging the U.S. Department of Health and Human Services to alter its regulations to allow new payment to cover outstanding debt. This would allow consumers to use their 2015 premiums to cover their unpaid 2014 months.

What's more, technical glitches continue to plague many insurers' payment systems, which contribute to the vast number of unpaid premiums. To make payment systems work,  insurers may need to establish two separate accounts for the same individual, notes Vox.

For more:
- here's the Vox article

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