What is a ‘new’ health plan? I’ve heard that only ‘new plans’ cover preventive care without co-pays.

Q. What is a “new” health plan? I’ve heard that only “new plans” cover preventive care without co-pays.

A.  True. If you bought insurance in the individual market sometime after March 23 2010, or if your employer purchased a group plan after that date, your policy is a “new plan.” That means that it covers the ACA’s essential health benefits, and that includes no-cost preventive care.

On the other hand, if you have individual or employer-based insurance that existed before March 23 2010, and no significant changes have been made to the policy since then, it is not a new plan. Rather, it is a “grandfathered plan.”

It’s important to note that in the individual market, grandfathered plans needed to have been purchased for each individual insured prior to March 23, 2010. But in the employer group market, the plan itself must have been purchased by the employer prior to March 23, 2010, although new employees can still enroll in the already-established grandfathered plan.

Grandfathered plans do not have to follow the new rules about covering preventive health care without co-pays or deductibles.

In 2015, one in four employees with group health insurance are still enrolled in grandfathered plans.


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