Grandfathered plan
Updated September 30, 2026
Definition
A health plan that was in place on or before March 23, 2010, and has kept its old status. It may not include some Affordable Care Act protections, like free preventive care.
A grandfathered plan is a health plan that existed on or before March 23, 2010. It can keep that status as long as it doesn't make big changes that cut benefits or raise costs. Your insurer must tell you if your plan is grandfathered.
These plans don't have to follow some Affordable Care Act rules. For example, a grandfathered plan may not cover preventive care for free. It may also skip certain appeal rights and the ban on yearly coverage limits.
This matters when a bill surprises you. Say a screening test you expected to be free shows a $200 charge. On a grandfathered plan, that charge may follow the plan's own rules. On most other plans, it may be a billing error worth questioning, as our guide to screening colonoscopy bills explains.
Related terms
Guides that use this term
- GuideCharged for a screening colonoscopy? Why and how to fix itA screening colonoscopy should usually cost $0. Learn what it costs, why it gets billed as diagnostic, and how to get your provider and plan to fix it.
- Start hereHow to appeal a health insurance denialA denied claim isn't the final word. Learn how to appeal an insurance denial, from internal appeal to external review, with deadlines for each plan type.
Sources
- Grandfathered health plan (glossary), HealthCare.gov. Accessed September 30, 2026.
- Grandfathered health insurance plans, HealthCare.gov. Accessed September 30, 2026.
This is general information, not legal or medical advice. Rules can depend on your plan and your state. Romi Care isn't an insurer, law firm, collection agency, or government program.