If you were enrolled in an individual plan from a private insurance companies before March 23, 2010, or if you participate in an employer-sponsored health insurance plan that has been in place since before the Affordable Care Act (ACA) became law on March 23, 2010 (even if you enrolled after that date), and it has not changed substantially in terms of costs and benefits provided, it is possible that your plan is grandfathered. Grandfathered plans may not be subject to some of the ACA’s requirements for health insurance plans.
For example, to comply with the ACA, health insurance providers can no long put an annual limit on the amount of benefits you receive. But this requirement may not apply to your plan if it is grandfathered, which mean you would be responsible for paying all medical expenses after that limit is reached.
Your insurance company is required to notify you if your plan is grandfathered, but if you have any doubt, ask your plan administrator. If you determine that you have a grandfathered plan, make sure you are aware of all the policies that may affect you. It is possible that your plan, even if it is grandfathered, may still offer these protections. No matter what answer you receive from your plan administrator, make sure to get it in writing and keep it in a safe place for future reference.
Grandfathered plans may not:
- Cover preventive care for free
- Guarantee your right to appeal
- Protect your choice of doctors and access to emergency care
- Be held accountable for excessive premium increases
In addition to these general exceptions, individual plans (those you buy yourself) possibly do not:
- give you unlimited annual coverage
- cover pre-existing conditions
Click here to learn more about these consumer protections put in place by the ACA to help you decide if you should consider changing your existing coverage.
If you are in a grandfathered plan and want out because you’re concerned it doesn’t provide the coverage you want, you may have to wait until the next open enrollment period for your plan (unless you have a qualifying event).
Note: This website and the information contained, expressed or implied herein are made available solely for general informational purposes and are not intended to be legal, tax, health, medical or professional advice or the sole source of information about health insurance coverage or specific health plans. While every effort is made to ensure that this information is accurate and current, SCAI makes no guarantees and disclaims any expressed or implied warranty or representation about its accuracy, relevance, timeliness, completeness or appropriateness for a particular purpose.