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Health Insurance Rate Increases And Grandfathered Health Plans – Should You Go Down With The Ship?

by admin on January 27, 2016

Everybody is getting large health insurance rate increases this year. The size of the increase is making many people look for alternative health insurance plans. One type of plan is being especially hard hit with double digit increases, and those are grandfathered health plans. We’ll cover what’s happening and what you can do to protect yourself from the rate increases that are taking place.

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You may be thinking, “What’s a grandfathered health insurance plan?” The answer is, if you have a health insurance plan that was in place on March 23rd of 2010, and you haven’t made any changes to your plan, you’re still in the same plan, then you have a grandfathered health insurance plan. If you’ve been in the same plan for 5, 10, 15 years, then you have a grandfathered health insurance plan.

Grandfathered plans have some special exemptions and characteristics, so we need to go over those in a little bit more detail. The easiest way to do that is to tell you a story about a recent client. That client’s name is Barry.

Barry and his wife are 52, and they have two daughters; one 21, and one that’s 16. Barry shared with me that their letter basically told them their new rate was going up almost 24% and they would be paying $1389 a month. They were in an Anthem PPO Share 5000 plan, and they’d been in that plan so long, he didn’t even remember when they actually started it. The rates had increased progressively from one year to the next.

But this year, the rates were finally high enough that he said he didn’t want to pay that much anymore, he wanted to find an alternative. So he called his agent, and then he called Anthem Blue Cross directly. In both cases, they told him to “just ride it out” and wait to see what happened in 2014, after the Affordable Care Act kicked in. That wasn’t an answer Barry was willing to live with because he wanted a solution today.

So when Barry called he shared the above information and his fear that he would have to pay higher rates. When queried about the health characteristics of his family, he said they were all healthy, and that other than one or two colds, they did preventive care and that was pretty much it. Their current plan was very rich in benefits that they weren’t making use of, based on what he’d described.

After running a set of quotes for the family, and scanning all of the different options, it became clear that one of the best options for them was the Health Net PPO Advantage 3500 plan. The reason is because it gave them two office visits for a simple copayment, and then all of the preventive care was free. That’s not something that they had in their PPO Share plan. They actually have to pay for their preventive care as part of their deductible costs in that plan.

The monthly premium on that Health Net plan was only $480 a month, so they were saving a little over $900 per month, or $10,900 per year. Barry really liked that. But he said, “There’s a big difference in benefits between these two plans. Can you show me a plan that’s a little bit closer to the benefits we have in our grandfathered plan, but at a lower cost?”

So looking through the list again, the closest match was the Cigna Open Access 5000/100% plan. It has a $5000 deductible and has unlimited office visits, which is very similar to the plan they currently have. But the monthly premium is only $928 a month. They could still save almost $500 per month, and $5500 in savings over the course of a year. Now, I don’t know about you, but saving $5500 to $10,900 is a pretty substantial amount of money for any family. Barry loved the heck out of that.