Grandfathered Health Insurance Plans

If you were enrolled in an individual plan from a private insurance company before March 23, 2010, or if you participate in an employer-sponsored health insurance plan that’s 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 hasn’t changed substantially in terms of costs and benefits provided, it’s 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 longer put an annual limit on the amount of benefits you receive. But this requirement may not apply to your plan if it’s grandfathered, which means you would be responsible for paying all medical expenses after that limit is reached.

Your health 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’s possible that your plan, even if it’s 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 do the following:

  • 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 won’t do the following:

  • Give you unlimited annual coverage
  • Cover preexisting conditions

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’re 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).