Federal Agencies Request Input on Grandfathered Plans

April 18, 2019

 

Under the Affordable Care Act (ACA), “grandfathered” health plans are plans that were in place before the passage of the ACA. These plans are not required to offer all of the benefits that the ACA requires of other plans, such as no-cost preventive services. In order to maintain grandfathered status, plans cannot substantially change the design of the plan as it existed when the ACA was implemented. Plans may not, for example, eliminate benefits for a certain condition, increase copays by more than a marginal amount, or increase coinsurance.

 

In late February, the Departments of Labor, Health and Human Services, and Treasury requested input regarding the challenges and benefits of maintaining grandfathered status. Specifically, the departments asked why plans want to to maintain grandfathered status, how the agencies can help plans maintain status, and what changes typically trigger the loss of status. 

 

While this request for information does not have any concrete consequences, it suggests that the agencies are open to relaxing rules regarding maintaining grandfathered status. The request for information is part of the larger goal of the Trump administration to minimize the impact of the ACA on plans and promote coverage options that do not comply with the ACA.

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