Individual Mandate

What is a grandfathered plan? How do I know if I have one?

Grandfathered plans are those that were in existence on March 23, 2010 and have stayed basically the same.  Grandfathered plans are not required to provide all of the benefits and consumer protections required by the Affordable Care Act.  For example, a grandfathered plan might not cover preventive health services, it might charge higher premiums based on health status or gender, and it might exclude coverage for pre-existing conditions.

If you buy coverage on your own and you first purchased your policy prior to March 23, 2010, it may be a grandfathered plan.

Some group plans offered by employers may also be grandfathered plans. A grandfathered group plan also must have been first established by the employer prior to March 23, 2010. To retain grandfather status, the group plan cannot be significantly changed (that is, the employer can’t significantly change covered benefits or cost sharing or the share of the plan premium that you are required to contribute.) Because employer plans tend to change from year to year, most have already lost grandfather status or will lose it over time. 

Employers with grandfathered group health plans are allowed to enroll new employees in the grandfathered plan. So even if you first joined a group health plan after March 23, 2010, you should ask about its grandfathered status. Your employer or your insurer must let you know if your health plan is grandfathered.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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