With the Affordable Care Act making changes to health care insurance plans, it’s not only mandatory that every person legally living within the United State have insurance, but that insurance must also comply with the different provisions of the Affordable Care Act as well. For those signing up for new insurance plans, you will have no worries as to whether the plan adheres to the ACA, as all new plans must adhere.

If you already have an insurance plan, you may be concerned about how your current policy adheres with the Affordable Care Act.  The first thing you need to know is the effective date of your policy. It’s important to note that the effective date may not be the same as your enrollment date. The effective date is the date in which the plan was first purchased, for instance, if you began working for a company five years after the company purchased an insurance plan, your enrollment date and the effective date of the policy will vary by five years.

Effective Date Prior to March 23, 2010

Your health care plan is considered to be grandfathered.  To learn more about grandfathered insurance programs, click here.

  • Your health plan must disclose, in its documentation, its grandfathered status. You can also check with your employer or health plan administrator to learn its status.
  • Grandfathered plans do not have to cover preventive care for free
  • Grandfathered plans do not have to guarantee your right to appeal
  • Grandfathered plans do not have to protect your choice of doctors
  • Grandfathered plans do not have to protect your access to emergency care
  • Grandfathered plans are not held accountable through the new Rate Review for excessive premium increases
  • Grandfathered plans (purchased as an individual only) do not have to end yearly limits on coverage
  • Grandfathered plans (purchased as an individual only)  do not have to cover you if you have a pre-existing health condition.

If you find you are involved in a grandfathered health insurance plan, you have the option of staying with your current health insurance program or opting for a new plan. The Health Care Marketplace is a good place to start your search for a new insurance policy.

Effective Date After March 23, 2010

Health care plans purchased and made effective after March 23, 2010 are mandated to adhere to the Affordable Care Act. In making changes to the policy so that it complies to the ADA, your policy may undergo increases to the premium as well. Your current policy will have to include – if it doesn’t already – the following:

  • The Essential Benefits Package
  • End lifetime limits on coverage
  • Cover adult children up to the age of 26 – regardless of their living situation or marital status.
  • Provide a standardized Summery of Benefits and Coverage (SBC) – which is a short and easy to understand summer of what plan covers and what it costs.
  • Insurance companies must spend your premiums on health care and not administrative costs and benefits.
  • 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
  • End yearly limits on coverage
  • Cover you even if you have a pre-existing health condition

What You Can Do

There are options available to you with the new Affordable Health Care Act.

Stay with your current policy: If you are comfortable with your current insurance plan – grandfathered or not – you can stay with your current plan without any interruption of coverage. Be sure that your current plan adheres to the provisions of the ACA by speaking to the manager of your health care plan.

Change your plan: Visit the health care marketplace today to compare benefits and pricing of the different health care policies available to you.