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Will my current health insurance plan need to change in 2014?

By on May 22nd, 2013
Filed: Facts, Health Insurance, Health Reform

Photo via David Paul Ohmer on FlickrWhen the 2010 health reform bill (the Affordable Care Act, or ACA) was signed into law, it effectively created three different classes of individually-purchased major medical health insurance plans: grandfathered plans, non-grandfathered plans, or new 2014 plans.

Do you know what kind of plan you have? Here’s a little summary of each one:

Grandfathered plans: These are individual of family insurance policies purchased and with coverage in effect before March 23, 2010, when the ACA was signed into law. These plans do not have to meet all the requirements of the health reform law. Their grandfathered into the system.

Non-grandfathered plans: These are individual or family policies purchased after March 23, 2010 and with coverage in effect prior to January 1, 2014. Non-grandfathered plans meet some of the new benefit standards required by the ACA, and some plans include them all. Plans that don’t meet all of the new benefit standards may need to be updated at some point in 2014.

New 2014 plans: These aren’t really available yet, but they’re insurance purchased after January 1, 2014.  These plans will include all the plan provisions required by ACA.

Let’s look at a number of different ACA provisions and see which plan types comply with them:

Access to Lost Coverage Due to Exceeded Limits: Policyholders who lost coverage after exceeding a policy’s lifetime coverage limit may now re-enroll in the same plan or one comparable and have coverage again. This applies to:

  • Grandfathered plans only (not applicable to the others)

No Lifetime Coverage Limits: The ACA does away with lifetime limits for coverage of most essential health benefits. This applies to:

  • Grandfathered plans
  • Non-grandfathered plans
  • New 2014 plans

Protection from Rescission:  Insurers cannot rescind (retroactively cancel) coverage unless intentional fraud is committed. This applies to:

  • Grandfathered plans
  • Non-grandfathered plans
  • New 2014 plans

Rescission Appeals: If insurers try to rescind coverage, customers have thirty days to appeal. This applies to:

  • Grandfathered plans
  • Non-grandfathered plans
  • New 2014 plans

Coverage of Children up to Age 26: Parent may keep adults children enrolled on family policies until adult children turn 26. This also applies to:

  • Grandfathered plans
  • Non-grandfathered plans
  • New 2014 plans

No Annual Coverage Limits: Annual dollar limits on coverage (for most services) go away. This applies to:

  • Non-grandfathered plans
  • New 2014 plans

No Cost-sharing for Preventive Services: Insurers are required to cover certain preventive medical services without cost-sharing. This applies to:

  • Non-grandfathered plans
  • New 2014 plans

Community Rating: Plans will no longer be priced individually, based on a person’s health, but based on the health of the overall community or group being covered. This applies only to:

  • New 2014 plans

Guaranteed Issue: An individual’s application for insurance can’t be declined because of a pre-existing medical condition. This applies only to:

  • New 2014 plans

Essential Health Benefits:  Each plan must cover health benefits in ten categories deemed to be essential. This applies only to:

  • New 2014 plans

Actuarial Values: Plans cover at least 60% of the total average annual costs an insurer expects to incur per customer. This applies only to:

  • New 2014 plans

Remember, many non-grandfathered plans will be brought into line with ACA rules in 2014. So, starting in January, a lot of these last few items will also apply to plans that are non-grandfathered today.

Image by Flickr user David Paul Ohmer.

 

About Nate Purpura


Nate Purpura is a 15-year veteran of print and broadcast journalism, corporate communications, PR and internet marketing. He’s spent the last decade working in the health care and insurance industries. Over fifteen years he’s covered numerous areas of health care including pharmaceuticals, health and wellness programs, chronic disease management programs, cutting-edge diagnostic tools, Medicare and health insurance, and online marketplaces (exchanges).

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