The Ultimate (Quick) Guide to Cancelling Your Marketplace Plan

Okay, as we discussed in “Five Things to Never Say to Customer Service” there is a difference – a big one – between cancelling a plan and terminating a plan. If you want your coverage to end you want it terminated.

But what if you want the plan gone altogether – for it to have never existed, then you do want a cancellation.

First off, outside Open Enrollment, cancellations aren’t usually granted. If you just want it gone, you are probably not going to get a cancellation. But if there is a problem that warrants a cancellation, the Exchange will be able to cancel, even outside Open Enrollment.

The first step is to call the Exchange. Explain to the rep what you want and why you want it. If the Exchange can go ahead with the cancellation, the rep will take care of it.

If not, the rep will explain why they can’t and what, if any, recourse you have.

In Colorado, for example, the Exchange will usually refer customers to the insurance company for authorization for cancellation. Now, this makes sense – the Exchange can’t see you claims history and has no way to know if you have paid claims. The nice hospital has already been paid – a cancellation will reverse that payment (and put you on the hook for it!) so it’s not a good idea for the Exchange to cancel the plan without the insurance company’s say so.

The problem is that it can become a merry-go-round – the Exchange sends you to the insurance company and the insurance company sends you back to the Exchange. Get off this merry-go-round – ask for a supervisor when you are referred back to the folks that just referred you to them or for a three way conference call so the Exchange, the insurance company and you can get straight what is or is not going to happen.

If you don’t get authorization for the cancellation and you believe your circumstances warrant it, then file an appeal with the Exchange and with the insurance company, both. Let them sort out who should act – don’t end up waiting weeks for one to decide just to have to appeal to the other – file both at the same time.

But be realistic – if both are telling you the same thing, you aren’t likely to get a cancellation by appealing. If they are contradicting each other, then by all means, appeal.

In the meantime, while you are waiting for the cancellation to be approved, request a termination from the Exchange. There is no point having to pay for additional months of coverage you already know you don’t need. What that means is the Exchange will end your coverage, probably at the end of the month you call them, so the insurance company doesn’t continue to bill you for the next month’s coverage. Once you know for certain you no longer need that plan, terminate it if they don’t immediately go ahead with the cancellation.

If, at long last, your cancellation is granted, the Exchange will actually cancel the plan. They will send that information to the insurance company. The insurance company will refund all the payments you made on that plan – because as far as they are concerned, there was nothing for you to have been paying for – the plan does not exist.

Final word of warning – do NOT ask for a cancellation unless you are absolutely sure there are no outstanding claims. You will owe all the money that the insurance company paid to your doctor, drug store, hospital, et al – and possibly even more than the company paid! The deal between the insurance company and the provider doesn’t apply if there is no insurance coverage – so the doctor’s agreement to accept a total of $75 for an office visit ($25 from you and $50 from the insurance company) no longer applies – and you may get a bill for the doctor’s full price office visit – which is gonna hurt if your doctor usually charges $200 instead of $75!

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