Under the health care law, most individual plans must offer new benefits and protections.
But some plans that have existed since before the health care law was passed, known as “grandfathered” plans, do not include some of those new benefits and protections. They are not Marketplace plans.
Some of them are changing to include these benefits. Others are being cancelled. Others are allowing current plan participants to renew through the 2016 plan year.
Note: If you had Marketplace coverage and your plan has been changed or cancelled, your situation is different. Learn about your plan options here.
When your non-Marketplace plan year ends
When your plan year for a non-Marketplace grandfathered plan ends, you’ll get a notice from your insurance company. When your plan year ends, you’ll face one of 3 situations:
- Your plan will be cancelled
- Your plan will change to include the new rights and protections
- Your insurance company will let you renew your plan without the new rights and protections
If your plan is cancelled
If your insurance company cancels your grandfathered plan, you have several choices. Call our special plan cancellation customer service number and a representative can explain your options: 1-866-837-0677 (TTY: 711) Monday through Friday, 9 a.m. to 7 p.m. ET.
Your options include:
- Buy a plan the company offers in its place. Your insurer must allow you to buy any of its other plans available to you.
- Buy a new plan in the Marketplace. You may qualify for lower costs on monthly premiums and out-of-pocket costs based on your income. All Marketplace plans include the new rights and protections. Because your coverage is ending, you qualify for a Special Enrollment Period that lets you enroll in a plan outside the Open Enrollment period. Note: If your plan is cancelled, in some cases you can buy a catastrophic health plan. See “What if my plan is cancelled and I can’t afford a new plan?” for more information.
- Buy a plan outside the Marketplace. This can be a good option if you don’t qualify based on your income. Most plans outside the Marketplace include the new rights and protections.
If your plan changes to include the new rights and protections
If your insurance company tells you that your plan will change to include the new rights and benefits, you have 3 options:
- Accept the plan and renew it. The price may go up.
- Look for other plans in the Marketplace to compare your options. Because your coverage is ending, you qualify for a Special Enrollment Period that lets you enroll in a plan outside the Open Enrollment period.
- Look for other plans outside the Marketplace. This is a good option if you don’t qualify for lower costs based on your income. If you do qualify for lower costs, you can get those savings only if you enroll through the Marketplace.
If your insurance company lets you renew your plan without the new rights and protections
If you have a grandfathered plan that doesn’t offer the new rights and protections, you may be able to renew it annually until 2016.
- Each state decides whether to allow insurers to do this, and then each insurer in those states decides whether to let people renew the coverage. Check with your insurance company to see if you can renew a plan that doesn’t offer the new rights and protections.
- Insurance companies can’t sell these grandfathered plans to new customers. They can only renew the plans for existing customers.
If your plan offers you the chance to renew
If your insurance company offers you the chance to renew this kind of plan, it must send you a notice explaining:
- Which rights and protections aren’t guaranteed in the plan
- That you can shop in the Marketplace, where all plans meet the new standards and you may qualify for lower costs based on your income
- That you may also buy new health insurance outside of the Marketplace, where you can’t get lower costs based on your income but most plans provide the new consumer protections
- Where you can learn more about all your options
More answers: Plan changes and cancellations
Source: HealthCare.gov, “If your grandfathered health plan is changed or cancelled”
http://www.healthcare.gov website. Accessed March 18, 2016. https://www.healthcare.gov/current-plan-changed-or-cancelled/
© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.