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If you can’t afford a U.S. health insurance premium, contact your insurer before the due date, confirm whether a grace period applies, and check whether you qualify for a lower-cost Marketplace plan, Medicaid, or CHIP. Don’t simply stop paying or cancel coverage: nonpayment can end a plan retroactively, and by itself usually does not give you a new chance to enroll.
1. Contact your insurer before the payment deadline
For a Marketplace plan, you pay the insurance company—not HealthCare.gov. HealthCare.gov says to pay the monthly premium in full to the insurer by the due date. Contact the company that bills you to confirm the amount owed, the deadline, accepted payment methods, and whether it can offer a payment arrangement. Get any arrangement and its terms confirmed by the insurer.
If you have just enrolled, coverage generally does not begin until you pay the first premium. Check with the insurer if you are unsure whether your payment was received or whether your coverage is active. See HealthCare.gov’s enrollment and first-payment guidance.
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A grace period is not the same for every policyholder. HealthCare.gov says that Marketplace enrollees who use a premium tax credit and have already paid at least one full month’s premium generally get a three-month grace period. It begins with the first missed month. If the balance remains unpaid, the insurer may terminate coverage retroactively to the end of that first unpaid month.
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Ask the insurer whether your claims are being paid while you are in the second or third month of the grace period. Do not assume a provider visit or prescription will be covered simply because your plan has not yet been terminated. If you do not receive a premium tax credit, your grace period may differ; ask your insurer and check with your state Department of Insurance. HealthCare.gov explains the Marketplace grace period and loss-of-coverage rules.
3. Don’t count on nonpayment to let you switch plans
If your Marketplace plan ends because you did not pay, that alone does not qualify you for a Special Enrollment Period. You may have to wait until the next Open Enrollment Period unless a separate qualifying event applies. Losing other health coverage can qualify in some circumstances, but eligibility and the enrollment window depend on the reason and timing. Check with the Marketplace before assuming you can enroll in a replacement plan.
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HealthCare.gov’s current general guidance lists Open Enrollment as November 1 through January 15 each year. Confirm the dates for the relevant plan year and your state Marketplace, since enrollment policies and deadlines can change.
4. Recheck your Marketplace savings and plan choices
Update your Marketplace application if your estimated income, household, address, or access to other coverage has changed. Then review the premium tax credit you may qualify for and compare the plans currently available to you. The credit depends on household size, expected income, and other eligibility factors; a prior year’s price is not a reliable guide to what you owe now.
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For 2026, HealthCare.gov says the additional pandemic-era Marketplace savings ended on December 31, 2025. As a result, some people may see higher premiums than they did previously. Check your current eligibility and plan prices rather than relying on an old quote. Use HealthCare.gov’s cost-saving guidance and its plan comparison tool.
5. Check whether Medicaid or CHIP could cover you
Medicaid and the Children’s Health Insurance Program (CHIP) may be options if you or a family member meet your state’s eligibility rules. You can apply through your state agency or the Marketplace. Eligibility rules vary by state and household circumstances.
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Do not cancel Marketplace coverage just because you expect to qualify. Wait for the state’s final decision, then coordinate the Marketplace plan’s end date with the Medicaid or CHIP start date to avoid a gap. Qualifying for Medicaid or CHIP generally means you are no longer eligible for Marketplace premium tax credits. If you keep taking the credit after you become ineligible, you may have to repay it when you file taxes. Review HealthCare.gov’s Medicaid and CHIP information and its guidance on ending Marketplace coverage when Medicaid or CHIP begins.
6. Compare the full cost and access to care
A plan with a lower monthly premium can still cost more overall if it has higher out-of-pocket costs or does not include the care you need. Compare these details before switching:
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- Monthly premium: Compare what you would actually pay after any premium tax credit.
- Deductible and cost-sharing: Check deductibles, copays, and coinsurance, and consider how often you expect to need care.
- Doctors and hospitals: Confirm that your providers and preferred facilities are in the plan’s network.
- Prescriptions and benefits: Check that your medications are covered. Marketplace plans cover essential health benefits, including prescription drugs, emergency services, hospitalization, lab services, and mental health and substance-use services, but plan details differ.
- Eligibility and timing: Confirm that you can enroll in the option you are considering and establish its start date before ending other coverage.
- Coverage continuity: Consider whether the change will preserve comprehensive coverage without a gap.
Compare the actual plan documents and provider directories, not only headline premium amounts. HealthCare.gov provides an overview of what Marketplace plans cover.
7. Get free, impartial enrollment help
If you are unsure how to update an application, compare plans, or check eligibility, a Marketplace-trained assister can explain your options and help with enrollment. HealthCare.gov describes this assistance as free, fair, and impartial. Find help through HealthCare.gov’s local assistance directory.
Pay premiums to your insurance company. Be wary of anyone demanding money to qualify you for coverage; ask the Marketplace or your state agency to verify an offer or service you do not understand.
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