2026 Premium Grace Periods and Eligibility Verification

Date: 01/08/26

Under the Affordable Care Act, Ambetter Health provides a three-month grace period for members receiving Advance Premium Tax Credits (APTCs) before coverage is terminated.

Important: For members not receiving APTCs, the standard grace period is 30 days and claims will not be paid during the first month of nonpayment.

Grace Period Timelines for Members Receiving APTCs:

First Month of Non-payment:

• Eligibility verification will indicate the member is delinquent due to nonpayment.
• Claims may still be submitted and will be paid during this period.

Months Two and Three:

• Eligibility verification will show the member as being in a suspended status.
• Claims submitted during this time may be pended or denied, depending on plan rules and payment status.

If full premium payment is not received by the end of the grace period, the member’s policy will be terminated retroactively to the last date for which the premium was paid. The member may be held financially responsible for:

• Any covered services received during the grace period
• Any unpaid premiums

Best practice is to check members’ eligibility before providing services. You can check eligibility, member benefits and cost shares multiple ways.

1. Ambetter Secure Provider Portal
2.  Use the 24/7 Toll-Free IVR Line Phone: 1-833-863-1310 (TTY: 711)
3. Call Provider Services: 1-833-863-1310 (TTY: 711)

NOTE: When checking status of a member you may see one of the following:

1. Eligible: Member is eligible for services on the date of service
2. Not Eligible: Member is not eligible for services on the date of service
3. Delinquent Premium: Claims will be processed
4. Past Due Premium: Claims may be denied

For more information please refer to the 2026 Provider and Billing Manual (PDF)