Several weeks ago, we wrote about possible disincentives for doctors to accept health insurance sold on the marketplace (also known as exchanges).
A recent article in the Sacramento Bee highlights a loophole in the law that deserves a further look.
For subsidized policies sold in the exchanges, a provision in the Affordable Care Act (ACA) (federal law) provides for a three-month grace period during which the policyholder’s health insurance can not be canceled for non-payment of premium. But — and here’s the critical piece to note — insurers are only responsible for the first month; any medical expenses incurred during the second and third month that the premium is not paid (but the policy can not be canceled) will not be reimbursed by the insurance carrier.
Who will be stuck with the bill this situation? The provider — doctor, hospital, urgent care, etc.
Will this loophole, designed to protect low-income policyholders maintain their coverage if they are unable to pay their premiums for a couple of months, be exploited by unscrupulous individuals trying to game the system? Should physicians and hospitals be wary of accepting the plans sold in the exchanges? Will this in turn cause a shortage of providers for subsidized plans?
What do you think?