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My employer’s plan is grandfathered so it doesn’t cover preventive services. Can I shop for better coverage in the Marketplace if my job-based plan is grandfathered?

You can always shop for coverage in the Marketplace. However, you can only apply for premium tax credits if your job-based plan – whether it is a grandfathered plan or not – is unaffordable or if it doesn’t meet minimum value. Whether your employer’s health plan meets minimum value will depend on a number of factors. The Marketplace application includes a form with questions about job-based coverage. You should take this form to your employer and has them to fill it out. With that information the Marketplace will determine whether the plan meets minimum value. If it doesn’t, you may be able to qualify for premium tax credits to help pay for Marketplace coverage.

What is a grandfathered plan? How do I know if I have one?

Grandfathered plans are those that were in existence on March 23, 2010 and have stayed basically the same. If you buy coverage on your own and you first purchased your policy prior to March 23, 2010, it may be a grandfathered plan.  If you currently are covered under a non-group policy – whether it is grandfathered or not – you can also explore other qualified plans offered through the Marketplace and, if you prefer, you can switch to a new plan during Open Enrollment. To be eligible for a tax credit to help pay your premium – which will be based on your income – you would have to switch to a plan offered through the Marketplace.  Some group plans offered by employers may also be grandfathered plans. A grandfathered group plan also must have been first established prior to March 23, 2010. To retain grandfather status, the group plan cannot be significantly changed (that is, the employer can’t significantly change covered benefits or cost sharing or the share of the plan premium that you are required to contribute.) Because employer plans tend to change from year to year, most have already lost grandfather status or will lose it over time. Meanwhile, however, grandfathered plans are not required to provide all of the benefits and consumer protections required of other health plans. For example, a grandfathered health plan might not cover preventive health services.  Employers with grandfathered group health plans are allowed to enroll new employees in the grandfathered plan. So even if you first joined a group health plan after March 23, 2010, you should ask about its grandfathered status. Your employer or your insurer must let you know if your health plan is grandfathered.

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