Open enrollment for 2017 health coverage starts on November 1, 2016 – which will be here before you know it. But if you’re still covered under a plan you had prior to 2014, you haven’t had to do anything during the first three open enrollment periods. And you might be able to keep your plan again for 2017.
But that doesn’t necessarily mean that doing so will be the best option. It’s important to check out the other plans that will be available during open enrollment, and compare the premiums and coverage with the plan you’ve got now – keeping in mind that your current plan’s premium will likely increase again for 2017.
At acasignups, Charles Gaba estimates that there are still roughly 1.2 million people in the United States who have coverage under a grandfathered or grandmothered individual health plan. Grandfathered plans, which were already in force as of March 23, 2010, can continue to remain in force indefinitely, at the discretion of the health insurance carrier (carriers can, and do, terminate grandfathered plans), as long as they don’t make any substantial changes to the coverage.
But grandmothered plans are different. When the ACA was written, there was no provision for grandmothered plans. These are the plans that were purchased after the ACA was signed into law, but before October 1, 2013 when the exchanges opened for business. The original timeline was that they would all terminate either at the end of 2013, or at their renewal date in 2014. They would then be replaced by ACA-compliant coverage, and the only non-compliant plans remaining would be grandfathered plans.
But amid the uproar over cancelled plans in the fall of 2013, the Obama Administration announced a transitional relief program to allow non-grandfathered policies to renew at the end of 2013 (regardless of when their original renewal date would have been) and remain in force until their new renewal date in late 2014.
The final decision was left up to the states and to the health insurance carriers. Some states and carriers rejected the idea of creating a grandmothered plan provision, and required non-grandfathered health plans to terminate as planned. But many states and carriers accepted the new guidelines.
Some plans can stay in force until December 2017
In March 2014, HHS extended the transitional relief, permitting renewals as late as October 1, 2016, with the plans allowed to remain in force until as late as September 30, 2017.
Then, another extension was issued in February 2016, allowing grandmothered plans to continue to renew up until October 1, 2017, but with a termination date no later than December 31, 2017. (Carriers can utilize early renewal to make plan years begin January 1, 2017, or they can offer plan years of less than 12 months in order to let plans renew as late as October 2017, but terminate no later than December 31, 2017.) The latest extension is once again subject to the discretion of states and health insurance carriers.
What grandmothered plans must cover
Grandmothered plans must to comply with more ACA regulations than grandfathered plans. These include covering preventive care with no cost-sharing, and eliminating annual benefit limits for any essential health benefits (EHBs) that the plan covers.
(Grandmothered plans do not have to cover EHBs other than preventive care, but if they do provide coverage, they cannot place an annual dollar limit on it.) But grandmothered plans are exempt from some of the main consumer protections and mandates in the ACA.
States allowing renewals of grandmother plans
The transitional relief program leaves the final decisions up to states and carriers. There are 35 states where grandmothered plans are still in existence as of 2016.
As of May 2016, most of those states had already confirmed that they would go along with the provision to allow grandmothered plans to remain in force until the end of 2017, although carriers can opt to discontinue grandmothered plans instead.
Even if your plan is allowed to renew again for 2017, make sure you take a few minutes to shop around in your state’s exchange to see if there might be a better option available to you. Brokers and navigators in your community can provide assistance – free of charge – if you need it.
This page will be updated periodically to reflect additional state Insurance Commissioners’ decisions on this issue.
Grandmothered plans still exist in 2016 in the following states:
- Alabama (Plans can remain in force until December 2017. However, Blue Cross Blue Shield, which had 91% of the individual market in Alabama in 2013, decided not to renew non-compliant plans into 2014.)
- Alaska (Plans can remain in force through December 2017.)
- Arizona (Plans can remain in force through December 2017.)
- Arkansas (Plans can remain in force through December 2017.)
- Florida (Plans can remain in force until December 2017.)
- Georgia (Plans can remain in force through December 2017; the state did not issue any official guidance on the extension through December 2017, but communicated the information directly to the health insurance carriers.)
- Idaho (Plans can remain in force through December 2017. All grandmothered plan renewals on or after August 1, 2016 will have policy periods that extend through December 2017, with a consistent premium. So a plan that renews on August 1, 2016 will be renewed for a period of 17 months, with no rate changes during that time. Idaho has also addressed how accumulation periods for out-of-pocket costs will work on renewed grandmothered plans.)
- Illinois (Plans can remain in force through December 2017. Health plans cannot impose additional cost-sharing or premium increases in the final months of 2017; the renewal rates and out-of-pocket amounts that apply to the final renewal must be extended through the end of 2017 if the plan remains in force through the end of 2017.)
- Indiana (Plans can remain in force through December 2017.)
- Iowa (Plans can remain in force through December 2017.)
- Kansas (plans can remain in force through December 2017. The Kansas Insurance Department confirmed by phone that they are going along with the most recent guidance from CMS)
- Kentucky (Plans can remain in force until December 2017, per an email confirmation that was sent to carriers; some carriers had previously indicated that they would not allow grandmothered plans to extend beyond their 2014 renewal date.)
- Louisiana (Plans can remain in force through December 2017.)
- Maine (Anthem is the only individual market carrier in Maine carrier with grandmothered plans, and has filed a request to discontinue and replace all grandmothered and grandfathered plans as of January 2017).
- Michigan (Plans can remain in force through December 2017.)
- Mississippi (Plans can remain in force through December 2017; the Mississippi Insurance Department confirmed that the state is going along with the CMS guidance).
- Nebraska (Plans can remain in force through December 2017.)
- New Hampshire (Plans can remain in force through December 2017, but only if they’re renewed on or before January 1, 2017; no transitional plan renewals will be allowed after January 1, 2017 – plans will have to terminate and be replaced with ACA-compliant coverage as of their first renewal after January 1, 2017.)
- New Jersey (Plans can remain in force through December 2017.)
- North Carolina (Plans can remain in force through December 2017.)
- North Dakota (plans can remain in force through December 2017; no additional bulletins were issued, but the ND Insurance Department confirmed that the state will follow the latest guidance from CMS).
- Ohio (Plans can remain in force through December 2017.)
- Oklahoma (Plans can remain in force through December 2017.)
- South Carolina (Plans can remain in force through December 2017; 11 carriers opted to go along with the initial transitional relief – seven in the individual market, and six in the small-group market.)
- South Dakota (Plans can remain in force through December 2017.)
- Tennessee (Renewals are permitted; however BCBS, which insured 42 percent of the individual market in 2013, only renewed grandmothered plans through 2014.)
- Texas According to the Texas Department of Insurance, “there is nothing in Texas law prohibiting a carrier from renewing policies that are compliant with Texas requirements.” The state has not put out any official guidance on the latest extension rules from CMS, but they confirmed that carriers are free to follow the CMS guidance if they wish.
- Utah (Plans can remain in force through December 2017; Utah code 31A-30-117(3) allows non-grandfathered health plans to remain in force “to the extent permitted by the Centers for Medicare and Medicaid Services, so the extension issued by CMS in February 2016 is applicable in Utah.)
- Virginia (Plans can remain in force through December 2017. Legislation was passed in November 2014 that allowed for the renewal of non-ACA-compliant plans, but as it was very late in the year by that point, most carriers did not reverse course and allow those plans to renew for 2015. Golden Rule did, although the Bureau of Insurance noted that they were the only individual carrier to do so, and their enrollment is very small; the Bureau of Insurance did say that some small-group carriers may have extended transitional plans in the state, but they don’t track that.)
- West Virginia (the WV Office of the Insurance Commissioner confirmed by phone that West Virginia is allowing small group transitional plans to remain in force until as late as December 31, 2017, but only if they’re renewed by January 2017. Renewals of transitional plans will not be permitted after January 2017. The state also noted that there are no longer any transitional/grandmothered plans in West Virginia’s individual market; carriers have already terminated those plans and replaced them with ACA-compliant plans. West Virginia also filed a lawsuit against HHS over the extension of transitional plans in 2014. A US Court of Appeals ruling in July 2016 found that the state lacked standing in the case however.)
- Wisconsin (Plans can remain in force through December 2017.)
- Wyoming (Plans can remain in force through December 2017; Wyoming did not issue a written statement either way, which means they defaulted to the final extension issued by CMS.)
States not permitting renewals
Fifteen states and the District of Columbia have not extended renewals of non-ACA-compliant plans. (In most cases, this was effective as of 2014, although Oregon and Colorado allowed grandmothered plans to remain in force through the end of 2015.)
- California (Grandmothered small-group plans were allowed to remain in force through the end of 2015.)
- Colorado (The state allowed renewal through 2015, but not into 2016.)
- Connecticut (The state’s insurance commissioner has confirmed the state made no changes after the March 2014 announcement from HHS.)
- District of Columbia
- Minnesota (Non-grandfathered plans were required to be updated in order to become compliant with the ACA as of January 1, 2014. Carriers in Minnesota were not permitted to cancel coverage unless they left the market entirely.)
- Montana (State regulators didn’t prohibit renewal of grandmothered plans, although they did encourage carriers to switch to ACA-compliant plans instead of renewing grandmothered plans. Ultimately, all individual market carriers decided to switch to ACA-compliant plans, so there are no grandmothered plans in Montana.)
- New Mexico (Plans can not be renewed after the end of 2014, but may continue to exist until their 2015 renewal date. At that point, they must be replaced with ACA-compliant plans.)
- New York
- Oregon (Grandmothered plans could only remain in force through December 31, 2015.)
- Rhode Island
- Vermont (The state allowed 2013 plans to be extended only briefly, until March 31, 2014.)