You Already Have Health Insurance: Information on Grandfathered Health Plans

How Does the ACA Affect Me if I Already Have Health Insurance?

In most states, if you already have health insurance and you like it, you can keep it until 2017. You can keep your insurance even if it does not follow the ACA. However, your insurance will have to meet ACA regulations by 2017, unless it is a “grandfathered” plan. If your plan already meets ACA regulations, or if it changes to meet ACA regulations, it can continue.

Some states will not let insurance plans continue if they do not meet the ACA standards.

States that will not let insurance plans continue if they do not follow the ACA Year that the plan will be canceled
California, Connecticut, Delaware, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, Washington, Washington, DC 2014
Colorado, New Mexico 2015
Arizona, Illinois, Louisiana 2016
All other states 2017

Your plan is required to tell you if it does not meet the ACA regulations. It must also let you know about the Health Insurance Marketplace and that money may be available to help you pay for your insurance (in the form of subsidies).

What if I have COBRA?

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. COBRA allows people to keep the health insurance they got through their jobs after they:

Through COBRA, people can usually keep their insurance for 18 months.

If you have COBRA, you are considered to have health insurance. This means you do not have to pay the health insurance tax. For more information about the health insurance tax, click here.

The ACA does not affect COBRA. However, some people think it will be cheaper to buy insurance through the Health Insurance Marketplace. There will also be more insurance options through the Health Insurance Marketplace than through COBRA. For more information about the Health Insurance Marketplace, click here.

What if I am Self-Employed?

If you run a business that generates income, but you do not have employees, you are considered “self-employed.” You are self-employed even if you hire independent contractors to do some work.

People who are self-employed can buy health insurance through the Health Insurance Marketplace. If you have an individual health plan (not the kind you get through a job, but the kind you buy on your own), you may be able to change to a plan from the Marketplace.

To find out more about the Marketplace, click here. To find out more about changing your individual health plan, go to: https://www.healthcare.gov/what-if-i-want-to-change-individual-insurance-plans/

If you have employees whose income you report on a W-2, you are considered an “employer.” You may be able to get insurance for yourself and your workers through the Small Business Health Options Program (SHOP) Marketplace. To find out more about small businesses and the ACA, click here.

What is a Grandfathered Plan?

A grandfathered health plan does not have to follow certain parts of the Affordable Care Act. A health plan is grandfathered if:

  1. It was created on or before March 23, 2010 (the day President Obama signed the ACA into law)
  2. It has not made any big changes to premiums or benefits

How Do I Know if My Health Plan is Grandfathered?

You could have a grandfathered health plan if:

To find out if you have a grandfathered health plan:

What do Grandfathered Plans NOT Have to Cover?

A grandfathered plan does NOT have to:

Grandfathered INDIVIDUAL health plans (not the kind you get through work, but the kind you buy on your own) do not have to cover the above list, AND they do NOT have to:

What Do Grandfathered Plans HAVE to Cover?

All insurance plans, including grandfathered plans, must:

When Does a Grandfathered Plan Stop Being Grandfathered?

A grandfathered health plan stops being grandfathered when it makes big changes to your insurance. These changes usually decrease your benefits or increase your costs. However, grandfathered plans can make routine changes, such as adding benefits or raising premiums to keep up with inflation, and still stay grandfathered.

Where Can I Find More Information

Information from HealthCare.gov about grandfathered plans:
https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/

A short publication developed by Families USA with a nice table comparing grandfathered and non-grandfathered plans:
http://www.familiesusa.org/assets/pdfs/health-reform/Grandfathered-Plans.pdf

An article by Kaiser Health News describing grandfathered plans:
http://www.kaiserhealthnews.org/Stories/2012/December/17/grandfathered-plans-faq.aspx