If you bought a health plan outside the Marketplace on or before March 23, 2010 and are still covered by it, you have a "grandfathered" plan. You may not have some rights and protections other plans offer under the Affordable Care Act (ACA).
When your grandfathered plan year ends, you’ll get a notice from your insurance company.
- If your grandfathered plan is canceled
You have 3 options:
- Buy another plan from the same company: They must allow you to buy any other plan available to you. The new plan will include the rights and protections.
- Buy a plan through the Marketplace: All Marketplace plans include ACA rights and protections. When you apply, you’ll find out if you qualify for savings based on your income.
- Buy a plan outside the Marketplace: This may be a good option if you don’t qualify for savings based on your income. But if you do qualify to save, you get the savings only if you enroll through the Marketplace. Most plans outside the Marketplace include the ACA rights and protections.
- For more information on canceled grandfathered plans, contact the Marketplace Call Center.
- If your grandfathered plan changes to include the ACA rights and protections
You have 3 options:
- Accept the plan and renew it: The price may go up and benefits may change, so read the offer carefully.
Buy a plan through the Marketplace: Losing health coverage qualifies you for a Special Enrollment Period, so you can enroll even outside the yearly Open Enrollment Period. Learn how. All Marketplace plans include the ACA rights and protections.
Buy a plan outside the Marketplace: This may be a good option if you don’t qualify for savings based on your income. But if you do qualify to save, you can get the savings only if you enroll through the Marketplace. Most plans outside the Marketplace include the rights and protections.
More answers: Grandfathered plan changes & cancelations
- What if my plan is canceled and I can’t afford a new one?
If your grandfathered plan is canceled and you think you can’t afford a Marketplace plan, you can apply for a hardship exemption. This allows you to buy a Catastrophic plan regardless of your age.
- A Catastrophic plan generally has lower premiums but requires you to pay nearly all your medical costs up to a certain amount, usually several thousand dollars.
- If you claim the exemption and don’t buy a Catastrophic plan, you won’t have to pay the penalty for not having coverage.
How to get a Catastrophic insurance plan:
- Call 1-800-318-2596 (TTY: 711), a special phone number for people whose plans have been canceled, Monday through Friday, 9 a.m. to 7 p.m.; Saturday and Sunday, 9 a.m. to 5 p.m. ET. We can provide information, plan options, and contact numbers for Catastrophic plans.
- Download and fill out a hardship exemption application. Select hardship exemption #13 on the form. You’ll need to provide the form and a copy of your cancellation notice to any insurance company selling Catastrophic plans, on or off the Marketplace. The insurance company will send everything to the Marketplace. We’ll confirm your hardship exemption later, but you can buy a Catastrophic plan without waiting.
- See a list of Catastrophic plans available in your area. You can buy one directly from the insurance companies.
- Important: If you buy a Catastrophic plan, you don’t qualify for savings based on your household size or income. You pay the standard price quoted by the insurance company.
- What if my plan ends outside Open Enrollment?
If your grandfathered plan ends outside Open Enrollment, you qualify for a Special Enrollment Period. This lets you enroll any time of year, even outside Open Enrollment.
- Your Special Enrollment Period starts 60 days before and ends 60 days after your plan’s cancelation date.
- If you miss this window, you’ll have to wait until the next Open Enrollment Period to sign up for a plan.
To avoid a gap in coverage, sign up for a new plan by the 15th of the last month of your current plan’s coverage. Coverage can begin the first day of the next month.
- Do I have to use the Marketplace to buy a replacement plan?
No. You can get coverage outside the Marketplace. But the rules and deadlines are slightly different.
- Health insurance companies selling plans outside the Marketplace must allow you to enroll from 30 days before to 30 days after your grandfathered plan renews or ends.
- If you miss this window, you can’t buy or change plans, inside or outside the Marketplace, unless you qualify for another Special Enrollment Period.