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  1. #1

    Default Can You Retraoctively Cancel a Marketplace Health Insurance Plan

    My question involves collection proceedings in the State of: PA

    In 2015, I personally enrolled in a Marketplace health and dental insurance plan for 2016. I paid my premiums all year long with no issues. In late 2016, my employer asked me if I wanted to participate in a SHOP plan, which is an employer paid Marketplace plan. After discussing the details I decided to take this option.

    My employer assured me that I was enrolled in the SHOP plan and that everything should be taken care of. Around December 2016, I began getting emails from the Marketplace stating that I was not enrolled in a plan and that the deadline for coverage was coming up..."enroll now!"

    I surmised that this was due to me not following through with the individual plans as I was now enrolled in the SHOP plan. Both the SHOP plan and the individual plan was through the same insurer, by the way, just different tiers of coverage (SHOP is Gold, Individual is Silver)

    I got one letter on 12/9 stating I was still enrolled in my old Silver plan, then on 12/16 I got a letter confirming enrollment in the Gold plan. However, I still received emails from the Marketplace well into January stating I was not enrolled in coverage! Again, I figured this must be a mistake as the most recent letter I got from the insurer stated I was indeed covered. Again, my assumption was that they didnt think I was enrolled as my SHOP plan superseded the old coverage.

    Then I started getting ID cards for both plans along with invoices. On 2/6/17, I called my provider to question these duplicate cards and to make sure only the one Gold plan was active. They confirmed, but the bills kept coming.

    I called the insurer again today 3/20 about the continued invoices. I mentioned the 2/6/17 call, but they said oh no, you have to cancel that policy through the marketplace! So I called the Marketplace and they said, yes you can't cancel through the insurer, you must notify us. And by the way, we can't or don't backdate cancellations EVEN if you had coverage through the same insurer since 1/1/2017. Hmmm.

    Well, as it stands now I have two plans, one paid by my employer and one that I haven't paid a cent towards and an invoice I owe over $1,000 to the insurer. Trying to determine what the best course of action is.

    I find it very unethical of the Marketplace to operate this way. They are saying that because the SHOP plans and the individual plans are administered by different divisions, it's my responsibility to cancel the coverage, even though both plans (and both coverage confirmation letters) came from the same insurer (even the same office address!). And, the insurer says there is nothing they can do either.

    I am still trying to sort this out with my employer, but he basically also said the individual plan is outside of the scope of his responsibility.

    So, if I can't pay these premiums, and the individual policy cancels for non payment, what will likely happen? The premiums for the SHOP plan are being paid by my employer, and my coverage under that plan has been paid since 1/1/17. Will the insurer sue me to get duplicate premiums for two different health policies on the same individual (me) for the same time frame? Is that legal?

  2. #2
    Join Date
    Sep 2005
    Behind a Desk

    Default Re: Can You Retraoctively Cancel a Marketplace Health Insurance Plan

    Assumptions are a dangerous thing. It's not unethical for an insurance company to require that you cancel policies in a specific manner, or to continue your coverage (and to bill you) through the date that you properly terminate the policy.

    You say "I called my provider to question these duplicate cards and to make sure only the one Gold plan was active. They confirmed, but the bills kept coming." Who did you speak with, do you have notes of their name, job position, and the date of the call, and exactly what did they confirm?

    If you don't pay your premiums, you can expect that coverage on the plan for which you default will be discontinued retroactive to the date of your default, and that if you received medical services that were paid by that insurance you will be billed by the provider when the insurer takes back the money that it paid.

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