What to Know if You Already Have Health Insurance

any people are concerned about whether they'll be able to keep their current health insurance policy under the health care law. If you already have insurance, you probably won't have to do anything. The health care law is designed to preserve existing job-based insurance programs and government programs. However, the law includes a requirement for you to maintain what's called minimum essential coverage. Most Americans already have health insurance that counts as minimum essential coverage and will be able to keep their plan.

The health care law's minimum essential coverage requirement is met by:

  • enrolling in a government program like Medicare, Medicaid and MIChild, Michigan's affordable health care plan for children in low-income households
  • employer-sponsored coverage (this includes COBRA coverage)
  • buying insurance through the Health Insurance Marketplace
  • buying insurance directly from an insurer on the individual market
  • Certain types of veterans health coverage administered by the Veterans Benefits Administration
  • Coverage provided to Peace Corps volunteers
  • Other plans may qualify; check with your insurer

Minimum essential coverage does not include plans that only cover vision or dental care, and some very limited coverage, like only for a specified disease or illness.

Changes in how you deal with your insurance company

The health care law offers everyone new rights and protections, including some that apply to how you will interact with your insurance company. Here are some of your new rights:

Your access to emergency services is protected.


Insurance providers are prohibited from charging you more out-of-pocket for getting emergency services at a location outside a plan's network. The law also made new rules on how plans will reimburse out-of-network health care providers.

You get a refund if your insurer underspends.

Insurance companies must now spend at least 80 percent (85 for insurers of large employers) of the premium dollars you pay on health care costs and quality improvement activities. If they spend too much on overhead like salaries, bonuses and administrative costs, they must provide rebates or premium reductions to policyholders.

You're protected from unreasonable rate increases.

Proposed rate increases of 10 percent or more by insurers in the individual and small group markets will have to be checked out by independent experts to make sure they are justified. This is called rate review.

You have the right to a quick appeal.

You can appeal an insurer's decisions to an independent review and receive a response within 72 hours in cases of urgent medical situations.

What does 'grandfathered' status mean?

If your plan is "grandfathered," meaning it existed on or before March 23, 2010, and has stayed basically the same, you may not get all of the rights listed here. It's important to note that this depends on when the plan was created, not when you enrolled, so your plan may be grandfathered even if you joined it after that date. Review your policy information or check with your insurer to find out if your plan is grandfathered. Grandfathered plans don't have to:

  • Guarantee your right to appeal
  • Protect your choice of doctors
  • Refrain from charging more for out-of-network emergency services
  • Be held accountable through rate review for excessive premium increases
  • Cover preventative care for free
  • In addition to the above, grandfathered individual health insurance plans (the kind you buy yourself, not the kind you get from an employer) don't have to:
  • End yearly limits on coverage
  • Cover you if you have a pre-existing health condition

AARP, American Public Health Association, Centers for Medicare & Medicaid Services, Consumer Reports, FAIR Health, Inc., HealthCare.gov, Internal Revenue Service, Kaiser Family Foundation, Medicaid.gov, Michigan Department of Community Health, Michigan Department of Insurance and Financial Services, U.S. Chamber of Commerce, U.S. Department of Health and Human Services, U.S. Department of Veterans Affairs.

Every effort was made to provide clear, accurate information about health care reform. We verified any information we had with first-tier sources – those who are involved in this change and its effect on our health care system. We also relied on well-respected national nonprofits, some who've done a masterful job of providing clear information to consumers. Our primary source of information was the Affordable Care Act's official website, HealthCare.gov. If you need additional information about how health care reform affects you, that would be your best place to start.

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