What can cause a grandfathered health plan to lose its status under the Affordable Care Act?

A grandfathered health plan retains its status under the Affordable Care Act (ACA) as long as it does not make significant changes to its benefits or cost-sharing requirements that would otherwise trigger a loss of that status. One key factor that can lead to the loss of grandfathered status is significantly raising co-insurance or deductibles. Such a change alters the financial structure for patients accessing care, making it less favorable than it was when the plan was first established.

The ACA includes specific rules aimed at maintaining certain protections for consumers, and significant increases in co-insurance or deductibles can be viewed as a reduction in the overall value of the coverage provided by the health plan. Therefore, the act of significantly raising these cost-sharing measures can be a clear indication that the plan is shifting away from the protections that were originally in place for its members, thus disqualifying it as a grandfathered plan.

In contrast, applying a lifetime dollar limit on essential health benefits is specifically prohibited under the ACA, as is increasing premiums significantly. Additionally, the concept of needing to "re-apply" for grandfathered status is not applicable to how grandfathered plans work under the ACA. Instead, maintaining that status is contingent upon not making significant changes as defined by the law