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16.05.2014
The Affordable Care Act defines a grandfathered plan as any health insurance plan in effect before March 23, 2010. You will need to find a new, ACA compliant plan or a plan that may be exempt from the Affordable Care Act. The insurance rep explained that was because the plan Naillon and her husband had through his job was “grandfathered” under the health law. Naillon, 33, would have to continue to pay a share of the cost of her pills, and the plan wouldn’t pay if she wanted to switch to an intrauterine device either.
About a quarter of insured workers remain covered by grandfathered plans, according to the Kaiser Family Foundation. In addition to not being required to cover preventive benefits without charge, grandfathered plans are exempt from some other health law requirements. When the health law passed, President Barack Obama sought to reassure anxious consumers by promising that “if you like your health care plan, you can keep it.”  Since then, the number of grandfathered plans has steadily declined.


Some big self-funded companies may keep generous grandfathered plans as a recruiting and retention tool, says Joe Kra, a partner and actuary at human resources consultant Mercer.
Smaller employers are more likely than large ones to be grandfathered at this point, Wojcik says. Some health policy experts have two words for the demise of grandfathered plans: Good riddance.
From an employee’s perspective, what grandfathered plans may lack in consumer protections they may make up for in reduced cost sharing, Kra says.
In order to retain their grandfathered status, for example, plans are limited in how much they can increase copayments and deductibles, among other things. A grandfathered health plan does not have to adhere to certain stipulations of the ACA and will stay the same without having to change to meet ACA guidelines.
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That meant the plan didn’t have to cover preventive services, including contraceptives, with no charge to consumers as Obamacare requires of other plans. They don’t have to guarantee members’ rights to appeal a decision by their health plan, for example, and may charge consumers higher copays or coinsurance for out-of-network emergency services. They also don’t have to comply with the law’s limits on annual out-of-pocket spending (currently $6,600 for someone in an individual plan and $13,200 for families), so consumers in these plans may be on the hook financially for more of their medical care. Small firms typically buy a plan from an insurer that pays their claims, unlike larger companies that often design their own plans and pay their employees’ claims directly. Continue offering the plan or coverage in effect on March 23, 2010 with limited changes, and thereby retain grandfathered status; 2. Significantly change the terms of the plan or coverage and comply with Affordable Care Act provisions from which grandfathered health plans are excepted; or 3.



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