Information About Health Coverage Rights and protections

Grandfathered health insurance plans

Grandfathered plans are health plans that were in existence on March 23, 2010, and haven’t been changed in ways that substantially cut benefits or increase costs for plan holders. If you have a grandfathered plan, you may not get some rights and protections that other plans offer. Your insurer must notify you if you have a grandfathered plan.

Switching to a Marketplace plan

If you have one of these plans you can switch to a Marketplace plan that covers pre-existing conditions.

  • You can do this during the annual Open Enrollment Period, but be sure to contact your insurance company first to learn about how and when you can cancel your current plan.
  • You can also buy a Marketplace plan outside the annual Open Enrollment Period when your grandfathered plan year ends. Your plan ending gives you a Special Enrollment Period to enroll in different coverage.

Types of grandfathered plans

Job-based grandfathered plans

Job-based grandfathered plans can enroll people after March 23, 2010, and still maintain their grandfathered status if the plans:

  • Haven’t been changed in ways that substantially cut benefits or increase costs for plan holders
  • Notify plan holders that they have a grandfathered plan
  • Have continuously covered at least one person since March 23, 2010.

Individual grandfathered plans

Individual grandfathered plans can’t newly enroll people after March 23, 2010, and have that new enrollment be considered a grandfathered policy. But insurance companies can continue to offer the grandfathered plans to people who were enrolled before that date.

An insurance company can also decide to stop offering a grandfathered plan. If it does, it must provide notice 90 days before the plan ends and offer enrollees other available coverage options. Learn more about plan cancellation.

How to find out if your plan is grandfathered

  • Check your plan’s materials: Health plans must disclose if they are grandfathered in all materials describing plan benefits. They must offer contact information.
  • Check with your employer or your health plan's benefits administrator.

What grandfathered plans do and don't have to cover

Protections that apply to all health plans

All health plans, including grandfathered plans, must:

Protections that DON’T apply to grandfathered plans

Grandfathered plans DON'T have to:

Protections that DON’T apply to individual grandfathered plans

In addition to the above, grandfathered individual health insurance plans (the kind you buy yourself, not the kind you get from an employer) don't have to:

Note: Some grandfathered plans offer protections they're not required to. Check with your insurance company or benefits administrator to learn if your grandfathered plan offers the rights and protections listed above.

Common questions

Yes. Grandfathered plans count as minimum essential coverage. This means you're considered covered under the health care law.
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
Yes. Plans can lose their grandfathered status if they make certain changes that lower your benefits or increase your costs.
In order to keep their grandfathered status, plans can't:
  • Significantly cut or lower coverage
  • Raise coinsurance of the allowed amount for the service
  • Significantly raise copayment charges
  • Significantly raise deductibles
  • Significantly lower employer contributions
  • Add or tighten a yearly limit on what the health plan pays

Ready to obtain the right health insurance? Check your eligibility for free or low cost health insurance through the marketplace in 4 simple steps...