Health Insurance Blog

Question #77 Is My Plan Grandfathered?

Posted by:
Tim Jackson
on
September 22, 2015
Wondering if your Health Insurance Plan is Grandfathered?

No, not this kind of Grandfathered.

The simplest answer is, it depends.

According to healthcare.gov: Grandfathered Plans are those that already existed before 03/10/2010 and kept the grandfathered status. Insurers have to notify you by law if they are grandfathered. If you are unsure whether or not your plan is grandfathered, you can either review your plan materials or contact your employer or HR personnel.

Does it matter?

Here is a glance of some pros and cons to a grandfathered plan taken from healthcare.gov.

Some things grandfathered plans do and don’t cover:

All health plans (including Grandfathered plans) must:

  • End lifetime limits on health insurance coverage
  • End arbitrary cancellations of health coverage
  • Cover adult children up to age 26
  • Provide a Summary of Benefits Statement

Grandfathered plans DON’T have to:

  • Cover preventive care for free–even though this will be true for a non-grandfathered plan.
  • Guarantee your right to appeal a coverage decision–ouch, this could cause some issues if you need to do this.
  • Protect your choice of doctors and access to emergency care.
  • Be held accountable through Rate Review for excessive premium increases

We hope this helps you understand whether or not you would be happy with your grandfathered health insurance plan.  Now, go hug your grandpa.

…oh wait, not that kind of Grandfather.

Much of the content from this blog was adapted from https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/

It was also written by Stephanie Haltiner, a Health Insurance Specialist.

Talk to Tim