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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Grandfathered Plans and Essential Health Benefits

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Question: I hear whispers that an individual who is insured now may not have to enroll in a plan with Essential Health Benefits during the open enrollment period - but instead can wait until the expiration date of their current plan. Can you clarify this?

Answer: That’s accurate in some cases. If you are covered by a plan that does not have grandfathered status, you may stay on the plan until the annual renewal date. You would then qualify for a special enrollment in a qualified health plan. If you are covered by a grandfathered plan, you may stay on that plan as long as it maintains its grandfathered status. Grandfathered plans have the ability to avoid several mandates and essential health benefits thus avoiding the increases in healthcare costs associated with those mandates.


Yes and Yes. the Affordable Care Act has a loophole that allows carriers to renew individual policyholders’ current health plans for up to a year without having to conform to Affordable Care Act’s consumer protections and market reforms. If carriers game the system this way it will lead to a smaller and potentially sicker pool of Exchange covered individuals in of the ACA’s critical first year. If the young and healthy opt to keep non-conforming plans because they cost less, rates could go up even higher than projected for others purchasing insurance through the Exchange in 2014.

Does this rule apply to both individual plans and to group plans. If someone waned to avoid Obamacae can they sign up with a new health care provider in December, 2013 and not have to change plans until December, 2014???

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