24 Feb New CMS Guidance for ACA: What Does it Mean for Grandfathered Plans?

The Department of Health and Human Services (HHS) yesterday issued a CMS guidance extending the allowable period under the Patient Protection and Affordable Care Act (ACA) for grandfathered plans that do not meet all of the ACA requirements for health insurance policies.  Previous to this guidance, the deadline was December 31, 2017 (plans ending by or before this date).  The extension is for one year, making the new deadline December 31, 2018.

The ACA put certain rules in place that apply to health policies issued by insurance companies.  Plans that take advantage of the extension will not be considered out of compliance if they do not abide by certain provisions of the Public Health Service Act which include consumer protections against premium increases based on gender and/or pre-existing condition, guaranteed renewability rules, mandated coverage of essential health benefits, and limits on annual out-of-pocket costs.

As reported by Modern Healthcare, “It’s estimated that fewer than one million people currently remain in grandmothered individual-market plans in the three dozen or so states that still allow them.” Therefore, if your practice is in a state that permits these types of plans, you may not see much of a change with regard to your patients due to this guidance, but if you were expecting all plans to fall under ACA rules by 2018, know that you’ll continue to see those grandfathered plans for another year.

For more information, please see the CMS guidance published here.



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