Health insurance rights & protections
Grandfathered health insurance plans
If you have a
, 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.
Types of grandfathered plans
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:
- Haven't been changed to substantially cut benefits or increase costs for plan holders
- Notify plan holders they have a grandfathered plan
- 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 considered a grandfathered policy. But insurance companies can continue to offer the grandfathered plans to people who were enrolled before that date.
- If an insurance company decides to stop offering a grandfathered plan, it must provide notice 90 days before the plan ends and offer other coverage options.
- Learn more about plan cancellation.
Rights & protections grandfathered plans do and don't cover
Grandfathered plans don't have to offer some rights and protections Marketplace plans do.
| Rights & protections | Grandfathered plans | Marketplace plans |
|---|---|---|
| End lifetime limits | Yes | Yes |
| End arbitrary cancellations | Yes | Yes |
| Cover adult children up to age 26 | Yes | Yes |
| Provide a Summary of Benefits and Coverage (SBC) | 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 |
| End yearly limits on coverage | No | Yes |
| A pre-existing health condition | 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.
Switching to a Marketplace plan
You may want to switch to a Marketplace plan that covers pre-existing conditions and offers the other rights and protections.
- During the yearly Open Enrollment Period: Coverage can start January 1. Be sure to contact your insurance company first to learn about how and when to cancel your current plan.
- With a : You can buy outside Open Enrollment when your grandfathered plan year ends or is canceled by your insurer. You have from 60 days before until 60 days after your plan ends to enroll.
More answers: Grandfathered health plans
Yes. For plan years through 2018, grandfathered plans count as
, 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:
Employee Benefits Security Administration, U.S. Department of Labor
www.dol.gov/agencies/ebsa
1-866-444-3272
Employee Benefits Security Administration, U.S. Department of Labor
www.dol.gov/agencies/ebsa
1-866-444-3272
Yes. Plans can lose their grandfathered status if they
- Significantly cut or lower coverage
- Raise
- Significantly raise
- Significantly raise
- Significantly lower employer contributions
- Add or decrease a yearly limit on what the health plan pays