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Are You in a “Grandfathered” Health Plan?



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Grandfathered Health Plans  source:  healthcare.gov


The Affordable Care Act exempts most plans that existed on March 23, 2010 — the day the law was enacted — from some of the law’s consumer protections. This preserves consumers’ rights to keep the coverage they already had before health reform.


What This Means for You


If you have health coverage from a plan that existed on March 23, 2010 — and that has covered at least one person continuously from that day forward — your plan may be considered a “grandfathered” plan.


This is true whether you are covered by an individual health insurance policy that you had on that date, or you are covered by a job-based health plan that your employer established before March 23, 2010. This is true even if you enrolled in that job-based plan sometime later.


A grandfathered health plan isn’t required to comply with some of the consumer protections of the Affordable Care Act that apply to other health plans that are not grandfathered.


Here’s a look at which consumer protections do and don’t apply to grandfathered plans:


Consumer Protections in the Health Care Law that DO Apply to Grandfathered Plans


Many of the law’s consumer protections that took effect on September 23, 2010 apply to all plans, whether they are grandfathered or not.


Please note that these consumer protections will be added to your plan when it begins a new plan year or policy year on or after September 23, 2010.


ALL health plans:





Consumer Protections in the Health Care Law that DO NOT Apply to Grandfathered Plans


Unlike other health plans, job-based plans and grandfathered plans are not required to:





Consumer Protections in the Health Care Law that also DO NOT Apply to Grandfathered INDIVIDUAL Plans


Grandfathered individual health insurance policies — not the kind you get through work — in addition to the exclusions above are not required to adopt the provisions of the law that:




Some Important Details


Grandfathered plans can lose their grandfathered status if they make certain significant changes that reduce benefits or increase costs to consumers. Read more about changes that will cause a health plan to lose grandfathered status.


Although grandfathered work-based plans can make only limited changes to the percent of the premium the employer contributes, grandfathered plans may still increase their total premium amount without losing grandfathered status.


If your plan loses its grandfathered status, all of the Affordable Care Act consumer protections would apply to you when your plan begins a new plan year or policy year.

To find out if your health plan is grandfathered:




If you experience significant changes in the benefits you receive or the costs you pay and you have a grandfathered employer-based group health plan, contact The U.S. Department of Labor at 1-866-444-3273 or visit www.dol.gov/ebsa/healthreform.


Health Care Reform Section

Timeline - What’s Changing and When

Small Business Tax Credit  by the IRS                                  

Grandfathered Health Plans  source: healthcare.gov


As used in connection with the Affordable Care Act: A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. A health plan must disclose in its plan materials whether it considers itself to be a grandfathered plan and must also advise consumers how to contact the U.S. Department of Labor or the U.S. Department of Health and Human Services with questions. (Note: If you are in a group health plan, the date you joined may not reflect the date the plan was created. New employees and new family members may be added to grandfathered group plans after March 23, 2010).



Timeline Past Present & Future Health Care Exchange Medical Loss Ratio (MLR) Business Tax Credit Essential Health Benefits Coverage & Admin Employer Mandates Grandfathered Plan

Health Care Reform Tools

Preventive Care Summary of Benefits