Is Your Plan "Grandfathered"? How to Find Out

healthcare reform The Affordable Care Act (ACA) introduces new rules that affect plan choices and costs for people who buy their own healthcare coverage. However, if you’re a long-standing member and have been on your plan since March 2010 or earlier, some of these changes may not apply to you. Here’s our 5-minute guide to what it means to be “grandfathered.”

How do you know if you have a grandfathered plan?

A grandfathered plan is one that already existed when healthcare reform came into effect on March 23, 2010. If you were enrolled on your current plan on this date, your plan is grandfathered. If you’re unsure, our customer service team can help you answer that question.

What does it mean to have a grandfathered plan?

Grandfathered plans are exempt from adding many requirements included in the ACA, which helps you control the cost of your coverage. The only way your plan could lose grandfathered status is if you change health plans (or Premera makes significant changes to your benefits, co-pays, coinsurance, or deductible, which we don’t plan to do).

On the plus side, having a grandfathered plan keeps your monthly rates down, because you’re not paying for additional coverage. However, it also means that you don’t have access to certain additional benefits, like preventive screenings at no out-of-pocket cost to you, which may be of interest to you.

What’s coming in 2014?

New plans will become available in October 2013 that have additional benefits to comply with the ACA. These plans will start to provide coverage from January 2014. Your plan will remain as it is today. You can decide if you want to remain on your current plan or switch to one of the new plans. 

What are the pros of staying on your grandfathered plan?

  • It may help keep your costs down as the new plans could be significantly more expensive
  • The way your plan works will not change
  • No need to fill out another application—if you do nothing, we’ll keep you on your current plan

What are the cons of staying on your grandfathered plan?

  • You will not be eligible for federal subsidies—starting in 2014 some people will be able to get federal assistance towards the cost of their health plan
  • You will not receive the additional benefits offered under the ACA, such as maternity and some new prescription drug benefits

How do I make sure I’m getting the best deal for me and my family?

We understand that you want to make sure you’re getting the right balance of costs and benefits to suit your family. We’ll be publishing details of our new plans later this year after they’re approved by state regulators, along with guidance to help you make the best choice for your individual needs, including information about how to access federal subsidies if you qualify for them.

1 Comment on Is Your Plan "Grandfathered"? How to Find Out

  1. California has already published a preview of their various plans submitted to date. When will previews of Washington’s plans arrive?

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