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What is a "grandfathered" health plan?


A grandfathered health plan is a plan that has existed continuously since before March 23, 2010 without significant changes in the plan. Grandfathered plans aren't subject to many of the requirements of the ACA, such as the requirement that plans cover essential health benefits.

Grandfathered plans that make certain changes, such as significant increases in their cost-sharing, (such as deductibles, coinsurance, copayments), or eliminating benefits to diagnose or treat a particular condition may lose grandfathered status and then would have to follow the ACA. Employer-sponsored plans that substantially raise the employee share of the premium also could lose grandfathered status.

A plan must indicate in the plan materials if it is a grandfathered plan. Also, consumers can check with their insurance company or employer.

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