Health insurance rights & protections

An individual health insurance policy purchased on or before March 23, 2010. These plans weren’t sold through the Marketplace, but by insurance companies, agents, or brokers. They may not include some rights and protections provided under the Affordable Care Act.

Refer to glossary for more details.

, you may not get some rights and protections that other plans offer under the Affordable Care Act. Your insurer must notify you if you have a grandfathered plan.

• If due to the cancelation you’re uncovered for all or part of 2018 or earlier, you may qualify for an exemption from the penalty for not having health insurance. Learn about this exemption. Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the fee no longer applies.
• Learn about your options for replacing your grandfathered plan.

Not sure if your plan is grandfathered? Check your plan's materials, or check with your employer or your health plan's benefits administrator.

Types of grandfathered plans

You may have a grandfathered plan through your job, or you may have bought one directly from an insurance company or agent or broker.

• Job-based grandfathered plans: Can enroll people after March 23, 2010, and still maintain their grandfathered status if the plans:
  • Haven't been changed to substantially cut benefits or increase costs for plan holders
  • Notify plan holders they have a grandfathered plan
  • Have continuously covered at least one person since March 23, 2010
  • If an insurance company decides to stop offering a grandfathered plan, it must provide notice 90 days before the plan ends and offer other coverage options.
  • Learn more about plan cancellation.

  Rights & protections grandfathered plans do and don't cover

  Grandfathered plans don't have to offer some rights and protections Marketplace plans do. What rights and protections grandfathered and Marketplace plans must offer

  Rights & protections	Grandfathered plans	Marketplace plans
  End lifetime limits	Yes	Yes
  End arbitrary cancellations	Yes	Yes
  Cover adult children up to age 26	Yes	Yes
  Provide a Summary of Benefits and Coverage (SBC)	Yes	Yes
  Spend the majority of your premiums on health care, not administrative costs and bonuses	Yes	Yes
  Offer free preventive care	No	Yes
  Guarantee your right to appeal a coverage decision	No	Yes
  Protect your choice of doctors and access to emergency care	No	Yes
  Be held accountable through Rate Review for excessive premium increases	No	Yes
  End yearly limits on coverage	No	Yes
  A pre-existing health condition	No	Yes

  Note: Some grandfathered plans offer protections they're not required to. Check with your insurance company or benefits administrator to learn about your benefits.

  Switching to a Marketplace plan

  You may want to switch to a Marketplace plan that covers pre-existing conditions and offers the other rights and protections.

  • During the yearly Open Enrollment Period: Coverage can start January 1. Be sure to contact your insurance company first to learn about how and when to cancel your current plan.
  • With a
  Special Enrollment Period

  A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount. Refer to glossary for more details.

  More answers: Grandfathered health plans

  If I have a grandfathered plan, am I considered covered?

  Yes. For plan years through 2018, grandfathered plans count as qualifying health coverage

  Any health insurance that meets the Affordable Care Act requirement for coverage. The fee for not having health insurance no longer applies. This means you no longer pay a tax penalty for not having health coverage.

  Refer to glossary for more details.

  , so you don’t have to pay the penalty for not having insurance.

  What if my grandfathered plan changes significantly?

  If you see major changes to your grandfathered job-based health plan's coverage or costs, contact:

  Employee Benefits Security Administration, U.S. Department of Labor

  Can a plan lose its grandfathered status?

  Yes. Plans can lose their grandfathered status if they
  • Significantly cut or lower coverage
  • Raise
  coinsurance

  The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible. Refer to glossary for more details.

  copayments

  A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible. Refer to glossary for more details.

  deductibles

  The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. Refer to glossary for more details.