What is a Grandfathered Health Plan?

Grandfathered plans are plans that were purchased before March 23, 2010. You can longer purchase grandfathered plans, but you are individuals are able to keep them as long as they would like. 

These plans have a grandfathered status and don’t have to follow ObamaCare’s rules and regulations or offer the same benefits, rights and protections as new plans. This means that on many old plans you can still be dropped form coverage for reasons other than fraud, be denied treatment for preexisting conditions, face annual and lifetime dollar limits and more. This means they can either not cover costs related to preexisting conditions or deny coverage all together for preexisting conditions.

Why would you keep a grandfathered plan if it has these restrictions?

It is possible you like your grandfathered health plan and that it makes perfect sense for you. Most grandfathered plans include access to large PPO plans that are no longer available. It is also possible you could be missing out on coverage that better meets your needs, especially if you qualify for a subsidy through healthcare.gov.

If your grandfathered health plan will remain available next year, you can renew it. Once you change to a non-grandfathered plan, you CANNOT go back or reenroll in your grandfathered plan. Make sure your decision is an informed one before making any changes.

Start by considering the following:

• Does your existing health plan still meet your healthcare needs? 
• Do you avoid getting preventive care due to cost?  
• Would changing plans mean losing benefits or networks you use?
• Does your grandfathered health plan still make sense financially? 
• Will your premium, deductible, copay or coinsurance amounts increase next year?  

• Would you be eligible for income-based subsidies such as premium tax credits and cost-sharing reductions if you purchased health insurance from a state-based or federally facilitated exchange?

• Does switching coverage mean losing access to your preferred healthcare providers and hospitals? 

Of course, shopping around and comparing health plans is the best way to know if your grandfathered coverage is still the right fit. When open enrollment begins Nov. 1, 2018, search plan options available through the healthcare.gov marketplace as well as in the private marketplace.