Health insurance pays for medical bills for services provided while the policy was in effect. Any medical services provided prior to or after the effective dates of the insurance policy are not covered. Past medical bills would only be covered by the health insurance in effect at the time of service.
Health Insurance Begins on the Effective Date
Each health insurance plan has an effective date.
The effective date is the date your coverage begins.
If you are an employee and enroll during your new hire enrollment, your effective date is at the end of your eligibility waiting period. If you enroll at open enrollment, it’s likely your effective date is January 1 although it could be a different time of year. You’ll want to check with your employer to see what your effective date is.
If you enroll in your health insurance on the Health Insurance Marketplace, you’ll learn the effective date when you enroll.
If your health insurance isn’t effective yet and you can safely delay any medical services until after the effective date, you should do that.
Can Health Insurance Be Backdated?
Some employers will allow a 30 day grace period after your effective date to enroll in health insurance. They will then backdate the coverage to the effective date you were originally eligible for. If they do this, you will still need to pay the back premium back to the effective date.
Coverage may also be backdated in the case of the birth of a child back to the date of birth. The child has to be enrolled within 30 days during a qualifying life event special enrollment period.
Health Insurance Covers You During The Plan Year
The plan year is the length of time your health insurance policy is in effect. The plan year for most of us is the same as a calendar year from January 1 through December 31. Your plan year might be different.
Once the plan year ends, a new one begins with a new effective date.
The Date of Service Has to Match The Plan Year
The date of service is the date medical services were provided. Any claim that is filed has to have a date of service that falls within dates that are during the plan year of your policy.
If the date of service does not fall into the plan year for the policy the claim is filed against, that claim will be denied.
If you had other coverage in effect in the past that was in effect on the date of service, you would want to file a claim against the policy that was in effect at that time.
How Far Back Does Health Insurance Cover?
There is no set time period for filing a health insurance claim. However, it is recommended that you file claims on a timely basis (within a year). If the date of service was within the plan year of that policy, you should file a claim even if you think it will be denied.
Health insurance coverage only goes back to the effective date of the policy.
Will My New Insurance Cover an Old Medical Bill?
Once the plan year ends, any old medical bill with a date of service prior to the new coverage effective date won’t be covered by your new insurance coverage. You’ll need to file a claim with the previous health insurance policy.
Medical Bills After Your Health Insurance Terminates
Any medical bills with a date of service after the termination date of your policy won’t be paid by the policy that terminated.
Cobra 60 Day Loophole
If you terminate your health insurance with your employer, you have 60 days to enroll in Cobra. Any cobra enrollment is retroactive to the date your previous plan terminated.
While you would have to pay back premiums to the termination date, if you originally hadn’t planned on enrolling in cobra but had a claim in the first month or so, you could potentially enroll in cobra to get that claim covered.
Conclusion: Will My Insurance Cover an Old Medical Bill?
Your insurance will only cover an old medical bill if that insurance was in effect on the date medical services were provided. If you did not have health insurance in effect on the date of service, any new insurance won’t pay for that old medical bill.
