Here's What You Need To Know About Obamacare And Your Health Plan

Oct 30, 2013
Originally published on October 30, 2013 6:00 pm
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ROBERT SIEGEL, HOST:

As we just heard, the latest complaints about the health law center on the question of whether you can keep your current health plan if you like it. There actually are rules associated with the law that try to protect that right, and NPR's Julie Rovner joins us in the studio now to try to explain how those rules work. Hi.

JULIE ROVNER, BYLINE: Hey, Robert.

SIEGEL: Now, these are called the grandfathering rules. How do they work?

ROVNER: Well, the idea is that any health plan that was in effect on the day the law was signed - which was March 23, 2010 - is allowed to remain, in effect, basically forever - as long as they don't make major changes.

SIEGEL: And what is the definition of a major change here?

ROVNER: I am glad you asked. Basically, the plan can't substantially change the benefits it offers, or increase its cost-sharing - things like copayments or deductibles - although it can raise premiums every year.

SIEGEL: But are there things that grandfathered policies or plans don't have to cover, that new policies would have to cover?

ROVNER: Yes. They don't have to cover free preventive care or the new essential benefits. But there are some things that all health plans do have to do - like end lifetime limits, and cover young adults up to age 26.

SIEGEL: How many of the plans in the individual market - which, again, is a small share of the overall health insurance market - how many of the plans that we've been hearing about are likely to be grandfathered?

ROVNER: Well, we don't have any really good numbers, but most of the experts I've been talking to think it's probably not very many. The individual insurance market tends to be a place where coverage turns over pretty quickly. And the idea that somebody will have had the exact, same policy since March of 2010 is considered pretty unlikely. So it seems that many of these policies that are being ended right now are probably not the ones that could have been continued indefinitely.

SIEGEL: So if these plans are not covered by the grandfathering clause, does that mean that they have to be ended as of Dec. 31st?

ROVNER: Actually, it doesn't. The rules of the health law are that any policy in effect this year can be renewed, or sold new, until the end of the year - for another 12 months. That means that if you have an individual policy you like, your insurer, theoretically, can renew it on Dec. 31st of 2013, through Dec. 31st of 2014, even if it's not in compliance with the health law's new rules.

SIEGEL: So there's a year grace period here. Why, then, are so many people getting notices telling them that these policies, if they have them, are finished, they can't get them again?

ROVNER: Apparently, this is a business decision that these insurers are making. It's not something that's technically being forced on them by the law, at least not for this year.

SIEGEL: Thank you, Julie.

ROVNER: You're welcome.

SIEGEL: That's NPR's Julie Rovner. Transcript provided by NPR, Copyright NPR.