Under the health care law, most individual plans must offer new benefits and protections.
But some plans that have existed since before the health care law was passed, known as "grandfathered" plans, do not include some of those new benefits and protections. They are not Marketplace plans.
Some of them are changing to include these benefits. Others are being cancelled. Others are allowing current plan participants to renew through the 2016 plan year.
Note: If you had 2014 Marketplace coverage and your plan has been changed or cancelled for 2015, your situation is different. Learn about your 2015 plan options here.
When your non-Marketplace plan year ends
When your plan year for a non-Marketplace grandfathered plan ends, you’ll get a notice from your insurance company. When your plan year ends, you’ll face one of 3 situations:
If your plan is cancelled
If your insurance company cancels your grandfathered plan, you have several choices. Call our special plan cancellation customer service number and a representative can explain your options: 1-866-837-0677 (TTY: 711) Monday through Friday, 9 a.m. to 7 p.m. ET.
Your options include:
- Buy a plan the company offers in its place. Your insurer must allow you to buy any of its other plans available to you.
- Buy a new plan in the Marketplace. You may qualify for lower costs on monthly premiums and out-of-pocket costs based on your income. All Marketplace plans include the new rights and protections. Because your coverage is ending, you qualify for a Special Enrollment Period that lets you enroll in a plan outside the Open Enrollment period. Note: If your plan is cancelled, in some cases you can buy a catastrophic health plan. See “What if my plan is cancelled and I can’t afford a new plan?” for more information.
- Buy a plan outside the Marketplace. This can be a good option if you don’t costs based on your income. Most plans outside the Marketplace include the new rights and protections.
If your plan changes to include the new rights and protections
If your insurance company tells you that your plan will change to include the new rights and benefits, you have 3 options:
- Accept the plan and renew it. The price may go up.
- Look for other plans in the Marketplace to compare your options. Because your coverage is ending, you qualify for a Special Enrollment Period that lets you enroll in a plan outside the Open Enrollment period.
- Look for other plans outside the Marketplace. This is a good option if you don’t qualify for lower costs based on your income. If you do qualify for lower costs, you can get those savings only if you enroll through the Marketplace.
If your insurance company lets you renew your plan without the new rights and protections
If you have a grandfathered plan that doesn’t offer the new rights and protections, you may be able to renew it annually until 2016.
- Each state decides whether to allow insurers to do this, and then each insurer in those states decides whether to let people renew the coverage. Check with your insurance company to see if you can renew a plan that doesn’t offer the new rights and protections.
- Insurance companies can’t sell these grandfathered plans to new customers. They can only renew the plans for existing customers.
If your plan offers you the chance to renew
If your insurance company offers you the chance to renew this kind of plan, it must send you a notice explaining:
- Which rights and protections aren’t guaranteed in the plan
- That you can shop in the Marketplace, where all plans meet the new standards and you may qualify for lower costs based on your income
- That you may also buy new health insurance outside of the Marketplace, where you can’t get lower costs based on your income but most plans provide the new consumer protections
- Where you can learn more about all your options
You have all of these options any time of year, not just during Open Enrollment. When your plan ends you qualify for a Special Enrollment Period. This lets you renew, buy, or change plans any time.
More Answers: Plan changes and cancellations
What if my plan is cancelled and I can’t afford a new plan?
If your non-Marketplace plan has been cancelled and you can’t afford a Marketplace plan to replace it, you can apply for a hardship exemption. This will allow you to buy a catastrophic plan.
A catastrophic plan generally requires you to pay all your medical costs up to a certain amount, usually several thousand dollars. These policies usually have lower premiums than a comprehensive plan, but cover you only if you need a lot of care. They basically protect you from worst-case scenarios.
How to get a catastrophic insurance plan:
- Call 1-866-837-0677 (TTY: 711), a special phone number for people whose plans have been cancelled. Service is available Monday through Friday, 9 a.m. to 7 p.m.; Saturday and Sunday, 9 a.m. to 5 p.m. ET. If you want to buy a catastrophic plan, we can provide information, plan options, and contact numbers.
- Download and fill out an application for a hardship exemption. Take this application to an insurance company selling catastrophic plans to show that you qualify to buy one. Be sure to include a copy of your cancellation notice. The insurance company will send the application to the Marketplace. We’ll confirm that you’re eligible for a hardship exemption later but you can buy a catastrophic plan right now. Note: When you fill out the form, be sure to answer that #13 is your reason for applying—that your individual policy has been cancelled and you feel you can’t afford coverage in the Marketplace.
- See a list of catastrophic plans available in your area. The list includes plan and company names and contact information. You can call the insurance companies directly to buy a catastrophic plan.
Important: If you buy a catastrophic plan, you can’t get lower costs 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 individual plan ends outside the Open Enrollment period, you can still use the Marketplace to get a new plan. Because the plan is ending, you get a Special Enrollment Period.
- Your Marketplace special enrollment period starts 60 days before your individual plan ends. If you wait until after you lose coverage to notify us, you have 60 days from the loss of the coverage to enroll in a new Marketplace plan.
- If you miss this window, you’ll have to wait until the next Open Enrollment period to sign up for a Marketplace plan.
- The Special Enrollment Period applies only at the end of a plan year or if your insurance company cancels your plan. Otherwise you must wait for the annual Marketplace Open Enrollment period before you can buy insurance.
If you want to avoid a gap in coverage, you should sign up for a new plan by the 15th of the last month of your current plan’s coverage. Coverage can begin on 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 have open enrollment from 30 days before your grandfathered individual plan renews until 30 days after.
Outside of an open enrollment period, you may not be able to buy or change health plans inside or outside the Marketplace unless you qualify for a Special Enrollment Period.