Under the Patient Protection and Affordable Care Act, qualified health plans must wait until premiums go unpaid for three months before discontinuing coverage for insured people who qualify for advance payment of premium tax credits. However, CMS recently issued a final rule allowing health plans to stop paying for claims filed after enrollees haven’t paid premiums for one month. If an enrollee hasn’t started paying premiums again after the three month grace period, health plans can deny payment for any claims filed during the second and third months of that interval, under the new policy.
The grace period protects low-income individuals who might have trouble paying premiums at certain times, AHA, FAH and AAMC leaders wrote in a letter to CMS Administrator Marilyn Tavenner. The groups expressed concern that the new CMS policy interpretation will result in healthcare providers not receiving payment for covered services from health insurers.
The groups asked Ms. Tavenner to revise the policy so health plans are required to pay for all covered services provided during the grace period. Their letter comes on the heels of a letter from the Medical Group Management Association — also addressed to Ms. Tavenner — saying the current grace period policy will potentially place a significant burden on physicians, who must try to collect the amount owed for the last two months of the grace period directly from patients.
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