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Can Our Health Care Plan Regain its Grandfathered Status?


Question: Our group health plan was grandfathered, but it lost that status in 2017. Is there anything we can do to regain its grandfathered status?

Answer: As you know, grandfathered plans are group health plans (or health insurance) that have continuously provided coverage since March 23, 2010, and haven’t undergone certain prohibited design changes since then.

These plans are excused from some requirements under the Affordable Care Act (ACA), such as coverage of preventive health services without cost-sharing, as well as provisions for an expanded appeals process and external claim review. They’re also subject to other provisions. Grandfathered status can be maintained indefinitely so long as:

  • The plan or coverage continues to cover at least one person
  • No prohibited plan design changes are made
  • The required disclosure and recordkeeping requirements are met

However, to answer your question, grandfathered status cannot be reclaimed after it’s lost.

The number of grandfathered plans has consistently decreased since the ACA was enacted. Federal agencies have reported that, in 2018, about 20 percent of employers that offered health benefits offered at least one grandfathered group health plan — down from 72 percent in 2011. And 16 percent of workers with employer-sponsored coverage were enrolled in a grandfathered group health plan in 2018 — down from 56 percent in 2011.

While acknowledging that some employers, insurers and participants continue to find value in grandfathered plans, the agencies have reiterated that there’s no authority for a health plan currently not grandfathered to obtain or regain grandfathered status.



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