Passive enrollments vs active enrollments (ACA/Marketplace insurance)

Take this from someone with knowledge of ACA enrollment process.

If you are enrolled in ACA/marketplace coverage and will be passively enrolled into the following plan year. Go in (Nov – Dec) and make a minor update/change to your enrollment for 1/1/25 coverage…something like a tiny financial change, or change plans, then the following day change your plan BACK to the original plan. Why you might ask? Because each time you make a change like this your insurance carrier will receive a new file from CMS with your enrollment changes, this will change your 2025 coverage from a “passive” enrollment to an “active” enrollment.

Again, why would you do this? Because if you default payments and end up terminating for non-payment during the current plan year (2024), this automatically cancels your 2025 passive enrollment – which cannot be reinstated regardless of reinstating/paying current for 2024 coverage. Going in and making a minor change with (Fed) marketplace in Nov-Dec prevents you from losing your “passive” enrollment because the changes you made (ex. plan/financial) changes your 2025 enrollment into an “active” enrollment and MUST be treated as a new enrollment – this safeguards you against losing your 2025 coverage 😉

Other info you might find helpful for ACA/Fed marketplace coverage:

Open Enrollment dates: 11/1 – 12/15 = 1/1/25 effective dates. 12/16 – 1/15 = 2/1/25 effective dates.

Be sure to update your financial info for the incoming plan year, CMS has a hard deadline for this and if you don’t update in time they will remove your subsidy/APTC and you’ll get smacked it a HUGE $$$ premium invoice – just saying, that’s not fun to work through and during open enrollment period it takes considerable time to open a CMS HICS appeal to get this fixed.

Delinquency: Are you receiving subsidy/APTC?

If not – you are in a “monthly” delinquency period, depending on your state/insurance company the deadlines will vary.

If yes – your initial month will be “monthly” delinquency, followed by “3 months/90 day grace period.” What does this mean? Say you are a brand new enrollment for 1/1/25, you MUST pay your Jan premiums by the deadline given by your states insurance, if you did, you will not fall into the 3mo/90 day grace period, meaning Feb/march/april premiums MUST be paid by end of April, if paid, the 3mo/90 days restarts for May/june/July, so on and so forth. If you DO NOT pay Feb/march/April by the end of April, your policy will turn back to the end of the first month of grace; for this example your policy will be termed back to end of Feb.

Let’s go further…what happens if you only paid for Feb/march, but not April? Your policy will still term end of Feb, and your insurance carrier will refund your March premiums. What if you didn’t pay any of Feb/march/April premiums? Your policy will still term end of Feb, but CMS will pay your Feb insurance premiums to your insurance carrier under what is called “APTC free month write-off” essentially giving you Feb as a free month of coverage. Wild, right?

Lots of info, but wanted to drop some info as it might help making open enrollment easier and prevent hours of being on the phone trying to get crap fixed during the busiest times of year for insurance 🫠 let me know if you have any questions 😅