Should You Grandfather Your Health Insurance Under the New Healthcare Reform?

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The Patient Protection and Affordable Care Act (Health Care Reform) provides an option for business group health insurance as well as individual health insurance to be grandfathered. If a health insurance policy was active prior to March 23, 2010 and the coverage elements remain essentially the same, it will be considered grandfathered. The primary benefit to grandfathering your health plan is to insulate yourself from the rate increases associated with the additional mandated provisions of Health Care Reform. Whether to grandfather your plan or not, depends on how the following mandates match your health care needs:

  • No annual dollar limits on essential covered health benefits
  • No cost sharing for preventive care services as determined by the US Preventive Services Task Force
  • No pre-existing condition exclusions for enrollees under 19

If you have a health condition where your health plan falls short with covering your treatment needs or you have significant out-of-pocket costs for wellness care, you may be best served by not grandfathering your health plan and accepting the Health Care Reform provisions. In my case, I’m better served with a grandfathered plan because I have an HSA (prior blog post link) plan that already provides 100% paid wellness care.

Grandfathered health plans can remain exempt of most Health Care Reform Provisions until January 1, 2014 as only limited changes occur.  Allowable changes include annual premium adjustments, changes of provider networks or adding/removing dependents to an existing policy.  Non-allowable changes for grandfathered plans include any increases in cost sharing for the insured such as increased deductibles, coinsurance or copays.

Please consider this only a brief overview of this element of Health Care Reform as there is a significant amount of additional detail involving the grandfathering issue. A good resource for more information is However, rather than trying to figure it all out for yourself, I strongly recommend you consult a health insurance professional to help you decide what’s best for you.  As always, we here at Affordable Health Solutions are eager to assist you. Email us today.