How much an insurance plan could change before losing its grandfathered status became a point of debate at Wednesday’s House Energy and Commerce hearing on HealthCare.gov.
Consumers can keep their existing health insurance plan if it qualifies for grandfathered status, which means that even if it isn’t completely compliant with the coverage requirements set down by the Affordable Care Act, it hasn’t changed enough to be considered a new plan.
Rep. Greg Walden, R-Ore., said the Health and Human Services Department issued regulations that made it so people would not be able to keep their existing coverage if their insurance company made small changes to the plan.
HHS Secretary Kathleen Sebelius disagreed with Walden’s assessment and said insurers had enough flexibility to make changes to pricing and coverage and still qualify for grandfathered status.
Millions of Americans are receiving notices that their plans will not exist in 2014 because their coverage is not comprehensive enough. Republicans have turned it into a talking point, arguing that the president lied to the American people when he said, “if you like your health plan, you can keep your health plan.”
The truth is, in order to retain grandfathered status, a plan cannot make changes to coinsurance, cost-sharing, or limits on annual benefits. The employer contribution to the premium cannot decrease by more than 5 percentage points. Deductibles, limits on out-of-pocket expenses, and co-pays cannot increase more than the medical price of inflation plus 15 percentage points.
A plan also cannot eliminate benefits or access to services for a particular condition. Employer-sponsored plans cannot change insurance carriers; however, if the employer is self-insured but contracts with an outside insurer, they can change who they contract with and retain grandfathered status.
Health Affairs, a health policy journal, has issued a brief about the regulations surrounding grandfathered plans, found here.
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