Grandfathered in plans are exempt!
Grandfathered plans
Grandfathered plans are those that were in existence on March 23, 2010 and haven’t been changed in ways that substantially cut benefits or increase costs for consumers. Insurers must notify consumers with these policies that they have a grandfathered plan. There are 2 types of grandfathered plans: job-based plans and individual plans (the kind you buy yourself, not through an employer).- Job-based grandfathered plans can enroll people after March 23, 2010 and still maintain their grandfathered status. They can do this as long as the plans haven’t been changed in ways that substantially cut benefits or increase costs for consumers, notify consumers with these policies that they have a grandfathered plan, and have continuously covered at least one person since March 23, 2010.
- 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.
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
Here's a quick look at the consumer protections that do and don't apply to grandfathered plans:All health plans must:
- End lifetime limits on coverage
- End arbitrary cancellations of health coverage
- Cover adult children up to age 26
- Provide a Summary of Benefits and Coverage (SBC), a short, easy-to-understand summary of what a plan covers and costs
- Hold insurance companies accountable to spend your premiums on health care, not administrative costs and bonuses
- Cover preventive care for free
- Guarantee your right to appeal
- Protect your choice of doctors and access to emergency care
- Be held accountable through Rate Review for excessive premium increases
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.
https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/
But why are some people receiving cancellation notices? These plans don't meet the criteria of a Grandfathered plan.
Timeline:
https://www.healthcare.gov/timeline-of-the-health-care-law/#part=6
Most are explained in more detail below.
2014
- January 1: Coverage begins in the Health Insurance Marketplace
- Coverage for pre-existing conditions
- Savings on monthly premiums and out-of-pocket costs
- Medicaid expansion
- No more yearly limits on coverage
- Expanded small business tax credit
- March 31: Open enrollment closes
- 2015: Employer Shared Responsibility Payment (this is the one about 50 or more full time Employees. Below is the link to the website that goes into more detail.
2013
- October 1: Open enrollment in the Health Insurance Marketplace begins
2012
- New preventive services for women
- Summary of Benefits and Coverage (this means they have to explain the coverage in plan language that is easy to understand.)
2011
- Prescription drug discounts for seniors
- Free Medicare preventive services for seniors
- The 80/20 Rule (Medical Loss Ratio)
- Rate Review
2010
March 23, 2010: President Obama signs the Affordable Care Act- Coverage for children with pre-existing conditions
- Coverage for young adults under 26
- No more lifetime limits on coverage
- No more arbitrary cancellations or rescissions
- Right to appeal health plan decisions
- Consumer Assistance Program
- Small business tax credit
- Temporary coverage for people with pre-existing conditions
- Community Health Centers
In the last post I mentioned two different laws. I am reposting just the part about the Affordable Care Act to make it easier to understand.
1. Children under 19 can't be excluded for pre-existing conditions. It applies to everyone starting in 2014. If you privately bought your plan before March of 2010 you are "Grandfathered" and have to wait until 2014. If you bought your plan after March of 2010 it already applies.
2. If you're 26 or under you are eligible to stay on your parent's health plan even if you are married, not living with your parents, in school, not financially dependent on your parents and are eligible to be covered through an employer
3. Previously, insurers could retroactively cancel your coverage for an honest application mistake made by you or your employer. They could ask you to pay back what they have paid for as well. But not anymore. They can cancel your policy for intentional errors like false or incomplete information on your insurance application and if you fail to pay your premiums on time but not for honest little mistakes. They have to give you a 30 day appeal time before canceling the coverage as well.
4. You can now ask your plan to reconsider it's denial of a payment. The appeal forces them to look at their decision, They have to notify you why your claim was denied and you right to an internal and external appeal (if the internal appeal was unsuccessful).
5. There is no longer a lifetime limit to coverage. Apparently, there used to be a cap to what an insurance company would pay through a person's life for their care.
6. A company cannot raise your rates by more then 10% without giving their reasons for it. Those reasons can be found here:
http://www.HealthCare.gov
A rate review program on that site will tell you if your rate is unreasonable. For some states, a state regulator can approve or not approve of the rate hike. That is also the link for the marketplace to find insurance.
7. 80% for individuals and 85% for groups of 50 or more people; That's the percentage for how many premium dollars have to go to health care needs like doctor visits and medication costs. Anything above that means rebates to the customers (I mean patients). Rebates might include a rate adjustment, a check, or a refund to your debit or credit card.
8. no cost to patient preventative care. A lot is covered so I just included the link.
http://www.hhs.gov/healthcare/prevention/index.html
9. You can choose any primary doctor or Pediatrician from your network. I thought that was always the case though.
10. One thing that already kicked in (and has helped us) is a tax refund for high deductible plans. These are connected to a Health Savings Account.
Citation: http://www.treasury.gov/resource-center/faqs/taxes/Pages/Health-Savings-Accounts.aspx
Citation: http://www.hhs.gov/healthcare/rights/index.html
One thing that has been highly publicized is that full time employee rule. Employers with 50 or more employees are required to provide health insurance for all employees working 30 hours or more. Some greedy employers have cut employee hours in response to this. Yes, this applies to all companies with 50 or more Employees.
Every state has decided how they want to handle it. If you find you can't get a good rate, chances are your Governor is a Republican who refused to create an exchange or expand Medicaid. This is NOT the fault of Democrats in the Federal Government but Republicans in State Government. The Federal Government DID offer grant money to establish an exchange.
MAP EDIT: This map from Huffington Post shows the states that did NOT expand Medicare in light gray. Those that DID are in dark gray.
You have to look up your state's policy on if they joined the Medicaid expansion. The Federal government will provide some financial assistance for this. By law, everyone has to sign up for some sort of medical coverage by January of 2014 or they will have to pay a tax penalty. But using the link below helps you get the best quote for you so you are shopping for the best insurance. In theory, this will eventually force private insurers to provide better coverage to stay competitive. If that were to happen it's probably many years away.
Sign Up Here Now:
https://www.healthcare.gov/
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