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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 Plan Rates

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Question: I have a Blue Shield grandfathered health plan with a very high rate, especially in that it is rated higher because of a health condition upon initial application and approval (can’t get lower tier now either). I am looking at my health plan options to lower my premiums. Should I decide to keep my grandfathered plan come Jan 2014, will the Tier rating rate-up automatically be eliminated (and therefore my rate reduced), or can Blue Shield still keep the higher rating in place regardless of the ACA mandate to not rate on health or medical conditions?

Answer: Grandfathered benefit plans (benefits have not changed since March 23, 2010) are not required to meet ACA standard benefits, I believe that would include the premium rate-up for preexisting conditions. That means your current premium will not be reduced in 2014. You will probably want to change to a ACA compliant plan.

2 Comments

You’d have to weigh the difference in total cost versus the narrower network.

Wondering if carriers will be allowed or are going to significantly alter and reduce provider networks for existing grandfathered plans? Will doing so change grandfathered status? Shopping for alternatives to current grandfathered plans, considering Covered California plans, which I understand are to see a sizable provider network haircut compared with current carrier provider networks, and so wondering if there exists a strong advantage to having and maintaining a grandfathered plan over a Covered California plan, where a grandfathered plan’s provider network may in fact be sizably larger.

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