2018 Employer Health Benefits Survey
Section 13: Grandfathered Health Plans
The Affordable Care Act (ACA) exempts certain health plans that were in effect when the law was passed, referred to as grandfathered plans, from some standards in the law, including the requirement to cover preventive services without cost sharing, have an external appeals process, or comply with the new benefit and rating provisions in the small group market. In 2018, 20% of firms offering health benefits offer at least one grandfathered health plan, and 16% of covered workers are enrolled in a grandfathered plan.
As in years past, some firms had difficulty with the details of the term “grandfathering”, as described in the provisions of the ACA. We would note that smaller firms in particular appeared to have some confusion about whether or not they are grandfathered.
- Twenty percent of offering firms report having at least one grandfathered plan in 2018, similar to 23% in 2017 [Figure 13.1].
- Sixteen percent of covered workers are enrolled in a grandfathered health plan in 2018 [Figure 13.2].
- The percentage of covered workers enrolled in a grandfathered plan is similar to the percentage in 2017 (17%), but lower than previous years: 25% in 2015, 26% in 2014, and 36% in 2013 [Figure 13.3].
- Grandfathered Plans
- In the employer-sponsored market, health plans that were in place when the ACA was enacted (March 2010) can be grandfathered health plans. Department of Health and Human Services (HHS) rules stipulate that firms cannot significantly change cost sharing, benefits, employer contributions, or access to coverage in grandfathered plans. New employees can enroll in a grandfathered plan as long as the firm has maintained consecutive enrollment in the plan. Grandfathered plans are exempted from many, but not all, of the ACA’s consumer protection provisions.