Health and Human Services estimated that between 21%-43% of all people insured would transition to the ACA exchanges. This is due to their health care plans losing grandfather status.

Healthcare.gov, the official Affordable Care Act website, run by Health and Human Services, notes that:

Grandfathered plans are those that were in existence on March 23, 2010 and have stayed basically the same. But job-based grandfathered plans can enroll people after that date and still maintain their grandfathered status. [...] Grandfathered plans can lose their grandfathered status if they make certain significant changes that reduce benefits or increase costs to consumers.

What qualifies as a significant change that would cause an insurance plan to lose grandfather status?

1 Answer 1


I found a list of changes to health plans that could cause them to lose their grandfather status. From the PDF:

  • An increase in a percentage cost-sharing requirement (i.e., coinsurance), regardless of the amount,
  • An increase in the deductible or out-of-pocket minimum by an amount that exceeds medical inflation plus 15 percentage points,
  • An increase in copayments if the increase exceeds the greater of $5 (adjusted for medical inflation) or medical inflation plus 15 percentage points. Medical inflation means the increase since March 2010 in the overall medical care component of the Consumer Price Index for all Urban Consumers (CPI-U) (unadjusted) published by the Department of Labor using the 1982-1984 base of 100.
  • A decrease in the employer's contribution rate by more than 5 percentage points (measured for each tier of coverage),
  • Elimination of all or substantially all of the benefits to diagnose or treat a particular condition, or
  • Adding a new overall annual dollar limit or decreasing the overall annual dollar limit in effect on March 23, 2010

Basically, plans will lose grandfather status if they substantially reduce coverage or increase in cost well out of step with medical inflation.

  • 1
    +1 nice source. I tried to read/search the actual government regulations, but it was becoming tl/dr.
    – user1873
    Nov 3, 2013 at 5:16

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