You are likely already aware of the worrisome time for physicians under the Affordable Care Act (ACA) called the “grace period.” That kicks in when a patient who files for health insurance in one of the insurance marketplaces fails to pay the premium in full. The non-payment triggers a 90-day grace period.
During the first 30 days of the grace period, the patient has health care coverage and their insurer will pay your claims. However, if the patient continues not to pay, the health insurer can suspend paying your claims from day 31 to day 90 of the grace period, at which time the patient will be terminated from the plan for non-payment of premium.
If the patient fully pays the premium before the end of the grace period, the patient retains health insurance coverage for the second and third months of the grace period – and your waiting claims will be paid.
However, when a patient does not fully pay the premium before the end of the grace period, the insurer will not extend coverage for the second or third months of the grace period and will deny all claims for services provided during that time. You would then need to seek payment from the patient.
During that second and third month, health insurers are required to notify you of patients' grace period status. But questions about the specifics of notification and other concerns have yet to be addressed. Therefore, it is important that you find out how your patients' contracted health insurers will notify you and handle other grace period issues.
To protect your practice and your own livelihood, take steps to minimize any potential non-payments due to cancellation of a patient’s coverage at the end of a grace period. To help you with that process, there’s now a checklist and other resources readily available from the AMA.
See a step-by-step guide to the grace period here.
Find model collection policies for grace period patients here.