Health Reform 2014: Is My Plan Grandfathered or Do I Have to Get a New One?

Massive changes are coming in 2014 that will probably impact you.
“If you like the plan you have, you can keep it.” Is that true for you? Well, it depends on when you started your plan. We’ll answer that question below, but first, a brief explanation about why it matters.
The majority of the provisions in the health reform law (“Obamacare”) take effect January 1, and you’re going to witness a big-time PR / public information campaign by the government aimed at getting you to ready.

Grandfathered Plan, not Grandfather’s plan. Photo Credit: LordFerguson via Compfight cc

The changes will be significant. There will be new benefits (mandated coverages) and the removal of the limitations that insurance companies have previously been able to put on underwriting (covering pre-existing conditions or charging more for the sick, for older policy holders, etc.). There are also restrictions on how plans are designed – on how high a deductible can be, for example.
While there will be good outcomes for many people, there’s one thing you probably won’t hear about in the PR campaign:
The price. It’s going to go up. Maybe dramatically.
If your plan is “grandfathered,” you’ll be able to keep it as it is. If not, then you’ll have to change at some point in 2014. So is your plan grandfathered? Here’s what you need to know:

Grandfathered Plans

Policies issued before March 23, 2010, are considered grandfathered and are exempt from some of the main provisions of HCR:

  • They are not required to cover preventive services without cost sharing.
  • They do not have to cover essential health benefits.
  • They should be able to maintain previous (higher) deductible and out-of-pocket expense levels.

Plans remain grandfathered so long as they do not make significant changes in coverage (like changing the deductible or benefit levels.

Non-grandfathered Plans

  • Any policy issued post signing of PPACA
  • Policies issued before March 23, 2010, but you made changes to the plan after the law was passed that changed the grandfathered status.
  • You will have to switch to a plan in 2014 and your new plan must conform to all applicable reform requirements. This change will happen when your policy renews in 2014.

If your plan is grandfathered, you should be able to keep it and see where the chips fall next year.
If your plan is not grandfathered, you’ll have some decisions to make. The next post will detail some things you could consider doing now to delay the impact.