Grandfathered health insurance plans

Grandfathered plans are health plans that were in existence on March 23, 2010, and haven’t been changed in ways that substantially cut benefits or increase costs for plan holders. If you have a grandfathered plan, you may not get some rights and protections that other plans offer. Your insurer must notify you if you have a grandfathered plan.

Switching to a Marketplace plan

If you have one of these plans you can switch to a Marketplace plan that covers pre-existing conditions.

You can do this during the annual Open Enrollment Period, but be sure to contact your insurance company first to learn about how and when you can cancel your current plan.
You can also buy a Marketplace plan outside the annual Open Enrollment Period when your grandfathered plan year ends. Your plan ending gives you a Special Enrollment Period to enroll in different coverage.

Types of grandfathered plans

Job-based grandfathered plans

Job-based grandfathered plans can enroll people after March 23, 2010, and still maintain their grandfathered status if the plans:

Haven’t been changed in ways that substantially cut benefits or increase costs for plan holders
Notify plan holders that they have a grandfathered plan
Have continuously covered at least one person since March 23, 2010.

Individual grandfathered plans

Individual grandfathered plans can’t newly enroll people after March 23, 2010, and have that new enrollment be considered a grandfathered policy. But insurance companies can continue to offer the grandfathered plans to people who were enrolled before that date.

An insurance company can also decide to stop offering a grandfathered plan. If it does, it must provide notice 90 days before the plan ends and offer enrollees other available coverage options. Learn more about plan cancellation.

How to find out if your plan is grandfathered

Check your plan’s materials: Health plans must disclose if they are grandfathered in all materials describing plan benefits. They must offer contact information.
Check with your employer or your health plan's benefits administrator.

What grandfathered plans do and don't have to cover

Protections that apply to all health plans

All health plans, including grandfathered plans, must:

End lifetime limits on coverage
End arbitrary cancellations of health coverage
Cover adult children up to age 26
Provide a Summary of Benefits and Coverage (SBC), a short, easy-to-understand summary of what a plan covers and costs
Spend the majority of your premiums on health care, not administrative costs and bonuses

Protections that DON’T apply to grandfathered plans

Grandfathered plans DON'T have to:

Cover preventive care for free
Guarantee your right to appeal a coverage decision
Protect your choice of doctors and access to emergency care
Be held accountable through Rate Review for excessive premium increases

Protections that DON’T apply to individual grandfathered plans

In addition to the above, grandfathered individual health insurance plans (the kind you buy yourself, not the kind you get from an employer) don't have to:

Note: Some grandfathered plans offer protections they're not required to. Check with your insurance company or benefits administrator to learn if your grandfathered plan offers the rights and protections listed above.