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CMS Announces Extension of Grandmothered Plans Through 2020

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The Centers for Medicare & Medicaid Services (CMS) released guidance on March 25, 2019, extending grandmothered plans for one additional year.

Under this guidance, CMS will continue its non-enforcement policy for certain non-compliant Affordable Care Act (ACA) plans sold in the individual and small group market. These plans do not meet all of the many mandates and restrictions in the ACA, including such provisions related to premium rating rules, guaranteed availability and renewability, ban on pre-existing conditions, coverage of essential health benefits, among other requirements. Individuals and employers in these plans will be considered compliant with ACA market reform rules for policy years beginning on or before October 1, 2020, provided that all such coverage comes into compliance with the specified requirements by January 1, 2021.

CMS will work with issuers and States to implement this policy, including options such as allowing policy years that are shorter (but not longer) than 12 months or early renewals with a January 1, 2020, coverage start date. States can elect to extend the non-enforcement policy for shorter periods but may not extend beyond. States may choose to adopt the extended non-enforcement policy for individual only, small group only, or both individual and small group markets.

Current states allowing renewal of grandmothered plans:

  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Michigan
  • Mississippi
  • Missouri
  • Nebraska
  • New Hampshire
  • New Jersey
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Pennsylvania
  • South Carolina
  • South Dakota
  • Texas
  • Utah
  • Virginia
  • Wisconsin

The grandmother plan policy was initially announced in November 2013, by the Obama administration and has been extended each year since then. While this guidance refers to a “non-enforcement policy” and previous guidance referred to a “transitional policy,” the substance of the policy remains unchanged per CMS.

Date

Announcement

Notes

11/14/2013 President Obama announces ability to "keep existing plan" for 2014, if their state's DOI and their carrier allow it Some states already allowed, and group carriers offered early renewals:
  • Individual
  • Small Group (2-50)
3/5/2014 Center of Medicare and Medicaid Services (CMS) announces additional two-year extension Plan years on or before October 1, 2016:
  • Individual
  • Small Group (2-50)
2/29/2016 CMS announces an additional one-year extension Plan years on or before October 1, 2017 with policies ending December 31, 2017
  • Individual
  • Small Group (2-50)
2/23/2017 CMS announces an additional one-year extension Plan years on or before October 1, 2018 with policies ending December 31, 2018
  • Individual
  • Small Group (2-50)
4/9/2018 CMS announces an additional one-year extension Plan years on or before October 1, 2019 with policies ending December 31, 2019
  • Individual
  • Small Group (2-50)
3/25/2019 CMS announces an additional one-year extension Plan years on or before October 2, 2020 with policies coming into compliance by January 1, 2021
  • Individual
  • Small Group (2-50)

DDOWNLOAD THE INFOBRIEF: CMS Announces Extension of Grandmothered Plans Through 2020

 

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