If you are covered by a plan that existed March 23, 2010, your plan may be "grandfathered." You may not get some rights and protections that other plans offer.

Grandfathered plans

Grandfathered plans are those that were in existence on March 23, 2010 and haven’t been changed in ways that substantially cut benefits or increase costs for consumers. Insurers must notify consumers with these policies that they have a grandfathered plan.

There are 2 types of grandfathered plans: job-based plans and individual plans (the kind you buy yourself, not through an employer).

• Job-based grandfathered plans can enroll people after March 23, 2010 and still maintain their grandfathered status. They can do this as long as the plans haven’t been changed in ways that substantially cut benefits or increase costs for consumers, notify consumers with these policies that they have a grandfathered plan, and have continuously covered at least one person since March 23, 2010.
• 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

Here's a quick look at the consumer protections that do and don't apply to grandfathered plans:

All health 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
• Hold insurance companies accountable to spend your premiums on health care, not administrative costs and bonuses

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

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:

• End yearly limits on coverage
• Cover you if you have a pre-existing health condition

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.

More answers

• If I have a grandfathered plan am I considered covered?

  Yes. Grandfathered plans count as minimum essential coverage. This means you're considered covered under the health care law.

• What if my grandfathered plan changes significantly?

  If you see major changes to your grandfathered job-based health plan's coverage or costs, contact:

  Employee Benefits Security Administration, U.S. Department of Labor

  www.askebsa.dol.gov

  866-444-3272

• Can individual and job-based plans be grandfathered?

  Yes. A grandfathered plan can be an individual health insurance plan or a job-based plan. Any plan established before March 23, 2010, has covered at least one person continuously since then, and has met certain other requirements can be considered grandfathered.

• Can a plan lose its grandfathered status?

  Yes. Plans can lose their grandfathered status if they make certain changes that lower your benefits or increase your costs.

  In order to keep their grandfathered status, plans can't:

  • Significantly cut or lower coverage
  • Raise coinsurance of the allowed amount for the service.
  • Significantly raise copayment charges
  • Significantly raise deductibles
  • Significantly lower employer contributions
  • Add or tighten a yearly limit on what the health plan pays