If you have a grandfathered plan, you may not get some rights and protections that other plans offer under the Affordable Care Act. Your insurer must notify you if you have a grandfathered plan.
Not sure if your plan is grandfathered? Check your plan's materials, or check with your employer or your health plan's benefits administrator.
You may have a grandfathered plan through your job, or you may have bought one directly from an insurance company or agent or broker.
Job-based grandfathered plans: Can enroll people after March 23, 2010, and still maintain their grandfathered status if the plans:
Individual grandfathered plans: Can't newly enroll people after March 23, 2010 and have that new enrollment considered a grandfathered policy. But insurance companies can continue to offer the grandfathered plans to people who were enrolled before that date.
Grandfathered plans don't have to offer some rights and protections Marketplace plans do.
Rights & protections | Grandfathered plans | Marketplace plans |
---|---|---|
Yes | Yes | |
Yes | Yes | |
Yes | Yes | |
Yes | Yes | |
Spend the majority of your premiums on health care, not administrative costs and bonuses | Yes | Yes |
Offer free preventive care | No | Yes |
Guarantee your right to appeal a coverage decision | No | Yes |
Protect your choice of doctors and access to emergency care | No | Yes |
Be held accountable through Rate Review for excessive premium increases | No | Yes |
No | Yes | |
No | Yes |
Note: Some grandfathered plans offer protections they're not required to. Check with your insurance company or benefits administrator to learn about your benefits.
You may want to switch to a Marketplace plan that covers pre-existing conditions and offers the other rights and protections.
Yes. For plan years through 2018, grandfathered plans count as qualifying health coverage, so you don’t have to pay the penalty for not having insurance.
If you see major changes to your grandfathered job-based health plan's coverage or costs, contact:
Yes. Plans can lose their grandfathered status if they