Grandfathered Health Plans Under PPACA (P.L. 111-148)

Bernadette Fernandez  
Analyst in Health Care Financing

The Patient Protection and Affordable Care Act (P.L. 111-148, PPACA, as amended by the Health Care and Education Act, P.L. 111-152) includes provisions for the grandfathering of existing health insurance plans. Given that most Americans had private health insurance coverage on the date of enactment of PPACA, most Americans' health coverage will be affected by the grandfathering provisions. 

This report addresses key questions concerning grandfathered plans (e.g., who is covered under such a plan) and insurance reforms affecting such plans, including reporting and consumer information requirements, benefits package, and access to coverage. It also addresses issues regarding the discontinuation of grandfathered plans and interaction with the individual mandate. 

What Is a Grandfathered Health Plan? 

A grandfathered health plan is an existing group health plan1 or health insurance coverage (including coverage from the individual health insurance market) in which a person was enrolled on the date of enactment. Therefore, as long as a person was enrolled in a health insurance plan on March 23, 2010, that plan has been grandfathered. 

Who Is Allowed Coverage Under a Grandfathered Health Plan? 

Current enrollees in grandfathered health plans are allowed to re-enroll in that plan, even if renewal occurs after date of enactment. Family members are allowed to enroll in the grandfathered plan, if such enrollment is permitted under the terms of the plan in effect on the date of enactment. For grandfathered group plans, new employees (and their families) may enroll in such plans. 

What Insurance Reforms Are Imposed on Grandfathered Health Plans? 

Grandfathered health plans are exempt from the vast majority of the new insurance reforms. However, grandfathered plans are subject to a handful of requirements with different effective dates.2


Date of Report: April 7, 2010
Number of Pages: 5
Order Number: R41166
Price: $7.95

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