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Health Care Reform FAQs: What if I have a grandfathered plan?


“Grandfathered” plans are those that were in existence on March 23, 2010, and have stayed basically the same since then. These plans can enroll people after that date and still maintain their grandfathered status. The status depends on when the plan was created, not when you joined it. If you are covered by a grandfathered plan, you may not get some rights and protections that other plans offer.


Like other health plans, all grandfathered plans are required to end lifetime limits on coverage, end arbitrary cancellations of health coverage, cover adult children up to age 26, provide a summary of benefits and coverage and spend at least 80 percent of premiums on health care.


But unlike plans created after March 23, 2010, grandfathered plans do not need to cover preventive care for free, guarantee your right to appeal, protect your choice of doctors and access to emergency care, or publicly justify premium increases of 10 percent or more.


Additionally, individual grandfathered plans do not have to end yearly limits on coverage or provide coverage to people with pre-existing health conditions.


Have more questions? Contact Experient Health for more information about your health insurance needs.

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