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A Ramona artist weighs whether to stick with her current health plan, which is grandfathered into the Affordable Care Act, or seek a new plan with more protections.
Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours here.
Regina Wilson lives in Ramona. She was able to stop working a while ago and spends her time painting and volunteering for the Oceanside Museum of Art and conservancy projects in San Diego’s backcountry. Because she doesn’t work, she purchases an individual Anthem Blue Cross health plan that’s pretty expensive — $776 a month, up from around $660 last year.
By John Rosman, KPBS
Wilson was hoping for a break with the implementation of the Affordable Care Act, but it turns out the plan isn’t going to change next year. Here’s her question:
I have an individual plan and my insurance company said that it would be grandfathered in. How does that apply to me?
Lawmakers wanted to provide some stability for people who are already insured, either through their company or individually. So they decided some plans that existed before March 23, 2010, wouldn’t have to comply with all of the new regulations.
What they don’t have to do:
Rules they do have to follow:
To find out whether you’re in a grandfathered plan, follow Wilson’s lead and ask your provider. There are a lot of them out there; about half of the people who get their benefits through work are in one, according to the Kaiser Family Foundation.
But the number of people in these plans is shrinking and the trend is expected to continue as new plans go on line in October. The people who stick around may be in special courses of treatment and have relationships with their doctors they’re just not willing to disrupt, said Sibyl Bogardus of Hub International Insurance Services Inc. As the insurance pools for these plans get smaller and riskier, you can bet premium costs will go up.
Wilson plans to take a look at the state-run insurance market, Covered California, in October to see if she can get a better deal. Whatever she decides, she shouldn’t do it in haste. Bogardus said once you leave a grandfathered plan, you can’t get back in.
Check out last week’s Second Opinion: How does Obamacare Address End of Life Care?