Q: If I receive notice that patients who are covered by a health plan in the Affordable Care Act (ACA) exchange are within the three-month grace period for paying their premiums, may I just pay their premiums to make sure they have coverage while I provide services?
A. This is a risky practice. The Centers for Medicare & Medicaid Services issued a memo (PDF) on this very topic, instructing insurers to refuse these payments, and warning physicians and providers that the act of paying the patient responsibility could elicit regulatory scrutiny.
TMA also has an ethics opinion on the topic. That opinion holds that paying the premium is an ethical practice only if the physician does not directly or indirectly receive a benefit.
See more of TMA's Q&A for Texas physicians (Updated: December 2014 ) regarding the Affordable Care Act health insurance exchange plans. To help answer your patients' questions about the plans, go to www.texmed.org/heydoc.
NOTICE: The Texas Medical Association provides this information with the express understanding that 1) no attorney-client relationship exists, 2) neither TMA nor its attorneys are engaged in providing legal advice and 3) that the information is of a general character. This is not a substitute for the advice of an attorney. While every effort is made to ensure that content is complete, accurate and timely, TMA cannot guarantee the accuracy and totality of the information contained in this publication and assumes no legal responsibility for loss or damages resulting from the use of this content. You should not rely on this information when dealing with personal legal matters; rather legal advice from retained legal counsel should be sought. This information is provided as a commentary on legal issues and is not intended to provide advice on any specific legal matter.
Published Dec. 10, 2013
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March 30, 2017