FACT SHEET
Why the Affordable Care Act Matters For
Women: Maintaining Your Health
Coverage
OCTOBER 2015
The Affordable Care Act (ACA) is the greatest advance for women’s health in a generation.
Thanks to this law, women and families are able to find quality, affordable health
insurance. Nearly 18 million people have gained health care under the ACA and more than
11 million people signed up for marketplace plans in the second open enrollment period
alone.1 As open enrollment for 2016 nears, women and families need to know what steps, if
any, they should take to maintain their health coverage. The following information will
help consumers plan ahead so they can continue to access the health care coverage they
need.
Pay Your Monthly Premium On Time
A premium is the payment you make to your health insurer each month to pay for your
health coverage. If you have a monthly premium, it’s important that you pay it on time.
Paying your premium keeps you enrolled in your health plan. (Anyone planning to sign up
for coverage for the first time during the 2016 open enrollment period will need to pay at
least one month’s premium in full before coverage begins.)
What happens if I forget to pay my premium?
You must pay your monthly premium on time to keep your health insurance; insurers can
terminate your coverage if your premium isn’t paid.2 While your plan may offer a grace
period if you miss a premium payment – allowing you some time to get caught up – you
should do your best to pay your premium on time each month.
Who qualifies for a grace period and how long does it last?
Grace periods vary according to each state’s laws.3 However, there is a special three-month
grace period for people who qualify for and receive advanced premium tax credits. This
guaranteed grace period is available to eligible enrollees who chose to receive their
premium tax credits in advance.4 (To learn more about premium tax credits and who is
eligible to receive them, see the National Partnership’s Premium and Cost-Sharing
Assistance fact sheet, available here.) Consumers with advanced premium tax credits must
have paid at least one full month’s premium before they become eligible for a grace period.5
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What happens if my grace period expires?
If you don’t pay the full premium you owe by the end of the grace period, what happens
next may depend on where you live. State laws determine the required length of the grace
period and when coverage is considered to have ended if premiums are not paid.6 Read the
terms of your health plan carefully to understand the grace period policy.
 Generally, if an individual or family has not paid all outstanding premiums in full by
the time the grace period ends, coverage will be terminated. Insurance companies
must provide notice of termination before ending an individual’s coverage.7
 For individuals who are receiving advanced premium tax credits in the marketplace, if
the three-month grace period expires before the enrollee is able to pay the amount
owed in full, coverage will be considered to have ended on the last day of the first
month of the grace period.8 This means that insurers do not have to pay any claims
made in the second and third months of the grace period. (In this case, you could be
held responsible for paying for any health care services you received during the second
and third months of the grace period.)
Update the Marketplace on Your Life and Income Changes
Your eligibility for marketplace coverage and for premium tax credits and other costsharing assistance may change if you experience a significant life event or your income
changes. To ensure that you are receiving the right coverage at the right cost, update the
marketplace on any major life events (e.g., getting married, having a baby, moving) and on
changes in household income.
What kind of changes should I report to the marketplace?
You should update the marketplace on the following changes:
 Marriage or divorce;
 Having a child, adopting a child or placing a child for adoption or foster care;
 Income increases or decreases;
 Getting an offer of health coverage through a job, regardless of whether you enroll;
 Gaining public health coverage like Medicare, Medicaid or CHIP;
 Losing health coverage, such as job-based coverage;
 Moving to a new residence;
 Change in disability status;
 Gaining or losing a dependent;
 Someone on the plan turning 26 years old;
 Becoming pregnant;
 Change in tax filing status;
 Change in citizenship or immigration status;
 Incarceration or release from incarceration;
 Correction to name, date of birth or Social Security number;
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 Change in number of people in household due to a death;
 Change in status as an American Indian/Alaska Native or tribal status; and
 Any other changes that impact income or household size.9
When do changes need to be reported?
Update the marketplace about life and income changes as soon as possible: Some changes
can affect your eligibility for premium credits and cost-sharing subsidies. While you can
choose to receive electronic notifications reminding you to report changes, it is your
responsibility to report them promptly.10 You must report any changes that may affect
eligibility within 30 days of the change.11
You may sometimes receive notifications from the marketplace that a life or income change
has been detected. These notices will include information about how the life or income
changes may affect your eligibility for coverage or financial assistance, in addition to
information on how much time (30 days) you have to respond to the notice. If you receive
such a notice, respond to it as soon as possible. In some cases, failing to respond to the
notice will be interpreted as confirmation of the life or income change.12
How do I report life and income changes?
There are a few ways to report life and income changes:
 Online, by logging into your marketplace account, selecting your existing application
and choosing “Report a Life change.”
 By phone, at 1-800-318-2596 (TTY: 1-855-889-4325).
 In person. You can find local assistance here.
You cannot update changes by mail. Find more information on how to report changes here.
What happens if I do not report my life and income changes?
Income and life changes – such as an increase in household size, for example – can affect
eligibility for premium tax credits and cost-sharing assistance. Failure to update these
changes with the marketplace in real time, as they happen, can cause you to miss out on
additional financial assistance for which you are eligible. If you don’t receive the maximum
level of premium tax credits for which you were eligible during the year, you won’t be able
to claim them at tax time. If you fail to report life and income changes accurately and
receive higher levels of premium assistance than you are eligible for, you may be required
to pay back those subsidies at tax time.13 To learn more about possible tax implications, see
the National Partnership for Women & Families’ fact sheet on Preparing for Tax Time here.
If you experience a major life change that makes you eligible for a special enrollment period
(a time when you can enroll in coverage outside of the normal open enrollment period) and
don’t update the marketplace on major life events, you could miss out on the special
enrollment period. For more information on special enrollment periods, visit
HealthCare.gov.
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Visit the Marketplace During Open Enrollment
Health plans purchased in the marketplace offer coverage for one year; to renew your
coverage, you have to re-enroll each year during the “open enrollment” period. Open
enrollment to sign up for, or re-enroll in, 2016 coverage runs from November 1, 2015 to
January 31, 2016.
If you are already enrolled in a marketplace plan, you will receive a notice from the
marketplace before open enrollment begins. It will explain how to re-enroll and how to
report changes that affect eligibility and will include important dates regarding enrolling in
coverage for 2016.14 It may also contain information telling you that you may lose financial
assistance for 2016 if you do not take specific steps, or that you need to contact the
marketplace to update your eligibility.15
Prior to open enrollment, you will also receive a notification from your insurance company
explaining what will happen if you do not return to the marketplace to re-enroll or select a
new plan. It will provide information on the plan into which you will be automatically reenrolled, such as any important changes to benefits or cost.16
Automatic Re-Enrollment
If you are currently enrolled in a marketplace plan, visit the marketplace to re-enroll in
coverage, make changes to your plan or choose a new plan by December 15, 2015. If you do
not take action to update your plan or to re-enroll in your marketplace plan proactively, you
may by automatically re-enrolled in a health plan.
 If you live in a state with a state-based marketplace, visit your marketplace during reenrollment because rules and deadlines for automatic re-enrollment vary by state.
 If you live in a state with a federally facilitated marketplace (FFM) and do not take
any action by December 15, 2015, you will generally be automatically re-enrolled,
likely in the same plan you had in 2015.17 If that plan is no longer available, your
insurance company has to use a set of rules (a hierarchy; see below) to enroll you
automatically in a different plan that offers similar coverage and benefits.18
The insurer will start from the top of this hierarchy and work down until it finds the
most appropriate plan. (Note: it is important to understand the difference between a
plan and a product when interpreting this hierarchy: A product is the discrete
package of benefits with a particular network type [e.g., PPO or HMO]. A plan is a
benefits package. In the marketplace there will often be more than one plan option
within a given product.)
Automatic Re-Enrollment Hierarchy:
 If your plan is no longer available, you will be automatically enrolled in a plan (in
the same product) in the same metal level (gold, silver, etc.) as your current plan.
 If neither the plan you have now nor any plan in the product are available in the
same metal level as your current plan, you will be automatically enrolled in the
same product as your current plan in one metal level higher or lower.
 If there is no plan available in the same product in your current metal level or one
level higher or lower, you will be automatically enrolled in a plan in the same
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product in any metal level.
 If the insurer no longer offers the same product you have now in the marketplace,
your insurer can automatically enroll you in the most similar product offered by
the same insurer.19
You do not have to accept the plan in which you were automatically re-enrolled: During
open enrollment, you may always change plans. If you were automatically re-enrolled, your
insurer must inform you that you have this option.
How does automatic re-enrollment affect my premium tax credits?
While you will likely be automatically re-enrolled in a health care plan with financial
assistance (if you were receiving financial assistance in 2015), you should still visit the
marketplace during open enrollment to update your financial information. This will help
ensure that you are enrolling in your preferred plan and accessing the full amount of
financial assistance for which you are eligible. To make the automatic re-enrollment
process more convenient, you can grant the marketplace access to your tax information for
the purpose of determining eligibility for financial assistance.
If you do not update your financial and household information and select a plan through the
marketplace by December 15, 2015, you will be automatically re-enrolled in a plan that
includes financial assistance. The amount of federal financial assistance you receive will be
based on:
 Your projected household income from 2015, adjusted for 2016 (unless this is below
100 percent of the federal poverty level [FPL], in which case the most recent tax
information will be used).
 If projected 2015 household income is not available, your most recent IRS information,
adjusted for 2016. (If you show income above 400 percent FPL using this method, you
will be re-enrolled without financial assistance. If you show income below 100 percent
FPL using this method, the marketplace will use your 2014 income, adjusted for
2016).
 If 2015 and more recent information isn’t available, projected household income from
2014, adjusted for 2016.20
It’s important to know that you could be automatically re-enrolled in a marketplace plan
without financial assistance if you:
 Show household income above 500 percent FPL through your updated tax
information;
 Previously received financial assistance but did not allow the marketplace to request
your updated tax information; or
 Previously received financial assistance but did not comply with the requirement to
reconcile your advanced premium tax credits on your yearly tax return.21
To help avoid these situations, visit the marketplace to update your information and select
a plan during open enrollment to ensure you are receiving the right level of financial
assistance and are enrolled in the best health care plan for yourself and your family.
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1 Dept. of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation. (2015, September). Health Insurance Coverage and the Affordable Care Act.
Retrieved 2 October 2015, from http://aspe.hhs.gov/basic-report/health-insurance-coverage-and-affordable-care-act-september-2015; Dept. of Health & Human Services, Office
of the Assistant Secretary for Planning and Evaluation. (2015, March). Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report. Retrieved 2 October
2015, from http://aspe.hhs.gov/sites/default/files/pdf/83656/ib_2015mar_enrollment.pdf
2 Termination of coverage for qualified individuals, 45 CFR § 156.270(c) (2014).
3 Termination of coverage. 45 CFR § 155.430(d)(5) (2014).
4 Termination of coverage for qualified individuals, 45 CFR § 156.270(d) (2014).
5 Ibid.
6 See note 3.
7 Termination of coverage for qualified individuals, 45 CFR § 156.270(b) (2014).
8 Termination of coverage, 45 CFR § 155.430(d)(4) (2014).
9 Dept. of Health and Human Services, HealthCare.gov. Which Changes to Report. Retrieved 2 October 2015, from https://www.healthcare.gov/reporting-changes/whichchanges-to-report/
10 Eligibility Redetermination during a benefit year, 45 CFR § 155.330(c)(2) (2014).
11 Eligibility Redetermination during a benefit year, 45 CFR § 155.330(b)(1) (2014).
12 Eligibility Redetermination during a benefit year, 45 CFR § 155.330(e) (2014).
13 The Henry J. Kaiser Family Foundation. (2014, October). Explaining Health Care Reform: Questions About Health Insurance Subsidies. Retrieved 2 October 2015, from
http://kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/
14 Dept. of Health and Human Services, Centers for Medicare & Medicaid Services. Guidance on Annual Eligibility Redeterminations and Re-enrollments for Marketplace Coverage
for 2016. Retrieved 2 October 2015, from https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/annual-redeterminations-for-coverage-42215.pdf
15 Ibid.
16 Dept. of Health and Human Services, Centers for Medicare & Medicaid Services. (2015, June). 2016 Redetermination and Re-enrollment Basics for Assisters. Retrieved 2 October
2015, from https://marketplace.cms.gov/technical-assistance-resources/2016-redetermination-and-reenrollment.pdf
17 Ibid.
18 Annual eligibility redetermination (as amended effective October 6, 2014), 45 CFR § 155.335(j) (2014).
19 Ibid.
20 See note 16.
21 See note 16.
The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and
policies that help women and men meet the dual demands of work and family. More information is available at www.NationalPartnership.org.
© 2015 National Partnership for Women & Families. All rights reserved.
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