After you enroll in a health plan through Explore Health, you must pay your monthly premium to your insurance company to start and keep your coverage active.
Your premium is the amount you pay each month for health insurance.
Your first payment (binder payment)
Your first premium payment is called a binder payment.
This payment must usually be made before your coverage can begin.
The binder payment is typically:
- Your first month's premium
- Paid directly to your insurance company
Some insurance companies may allow a small unpaid balance and still start your coverage.
When is the first payment due?
Your insurance company will send you:
- A bill
- Payment instructions
- A payment deadline
Insurance companies must give you at least:
- 15 days after your coverage start date, or
- 15 days after the bill is sent
whichever is later.
If the payment is not made by the deadline, your coverage may be canceled.
Open Enrollment coverage dates
If you enroll during Open Enrollment between:
- November 1 and December 31
your coverage will usually start:
- January 1 of the following year
Monthly premium payments
After your first payment, you must continue paying your monthly premium on time.
Insurance companies must provide at least:
- A 30-day grace period for late payments
A grace period is extra time to make a payment before coverage ends.
What happens if you miss a payment?
What happens next depends on whether you receive financial help through Explore Health.
If you receive financial help (APTC)
If you receive advance premium tax credits (APTC), you usually get:
This means your coverage may continue for up to three months after a missed payment.
During this time:
- You still owe your premiums
- Your insurance company may delay payment of some claims after the first month, and some doctors may not provide services
If overdue premiums are not paid, your coverage may end.
If you do not receive financial help
If you do not receive APTC, you usually get:
If payment is not made during that time, your coverage may end.
Partial payments
Some insurance companies allow small unpaid balances.
For example:
- If you pay most of the amount due, your payment may still count as paid on time
Unpaid balances can continue to build over time.
If the unpaid amount becomes too large, your account may become past due and your coverage could be canceled.
Special Enrollment Period payments
If you enroll through a Special Enrollment Period:
- Your first payment rules are similar to Open Enrollment
Your insurance company must still provide:
- Time to receive your bill
- A payment deadline
- A grace period before cancellation
Retroactive coverage
Some Special Enrollment situations allow coverage to start in the past, such as after:
- Birth
- Adoption
- Loss of other coverage
If your coverage starts retroactively:
- You may need to pay premiums for past months plus the current month
Your insurance company will explain the amount due and payment deadlines.
Claims during a grace period
If you receive financial help and miss a payment:
- Your insurance company must continue paying covered claims during the first month of the grace period
During months two and three:
- Some claims may be delayed until your premiums are paid, and some doctors may not provide services
If coverage ends because premiums were not paid:
- Claims from later months may not be covered, and you will be responsible for paying the full charge for the services.
Avoid losing coverage
To help keep your coverage active:
- Open and review bills right away
- Pay premiums on time
- Watch for notices from your insurance company
- Update your address and contact information
- Contact your insurance company if you need help making payments
Need help?
Explore Health can help you:
- Understand premium payments
- Learn about grace periods
- Understand notices from your insurance company
- Find enrollment or payment support
Free help is available.