There’s a new federal rule that spells out what changes your health plan can make, and what changes it can’t make, if it wants to be exempt from some of the requirements of the new law. The Obama administration says the rule proves that you won’t be forced to switch health plans — that “if you like what you have, you can keep it.” The critics say it proves the opposite — that a lot of health plans will be forced to change.
The bottom line is, yes, some of the biggest protections in the new law will apply to all health plans, even the ones that already existed before the law. There are others that will not apply if your health plan stays pretty much the way it was before the law. If it stays the same, it will be considered a “grandfathered” health plan. If it changes its coverage too much, it will lose its “grandfathered” status and other benefits will kick in.
Honestly, though, you’ll get some of the biggest protections either way. The other protections you would get if your plan loses its “grandfathered” status are significant, but it’s not clear that, in the short term, they would make a huge difference in the costs of your plan — at least compared to the new protections you’ll get anyway.
For example, even if your health plan doesn’t change at all, it will have to stop putting lifetime limits on your benefits as of Sept. 23. It will also have to allow young adults to stay on their parents’ health plan until they turn 26 — which a lot of insurers have started doing early. And if you have individual coverage, as of Sept. 23, it will no longer be able to cancel your coverage if you get sick. (These reforms are discussed in Chapter 2 of the book, “Fixing the Insurance Market,” and Chapter 8, “While You’re Waiting … “)
The main early benefits that would kick in only if your health plan loses its “grandfathered” status, according to the new rule, are preventive care — at no cost to you — and direct access to OB-GYNs and pediatricians without having to get permission from your plan. Those will be welcome benefits for most people, but it’s not clear that they’re as big a deal as the protections even the “grandfathered” plans have to have.
Either way, all of this talk about “if you like what you have, you can keep it” is probably a bit exaggerated. The new protections may or may not raise costs — we’ll know more once they kick in — but they’re not going to force you to switch to a health plan you don’t like, which is what most people were worried about.
You can read the rule here, but it’s very dense and it may not be the first thing you’d want to read. Instead, you might want to read the administration’s fact sheet and Q&A first — with the understanding that they’re meant to put the rule in the best possible light — and then look at the rule to answer any questions you still have.
