Why Some Health Insurers Don't Cover Preventive Care

Grandfathered policies aren't required by the health care law to provide certain benefits.

As soon as the provisions of the new health care laws were introduced, my health insurance company sent me a letter stating that my plan’s preventive-care coverage will not change because it has been grandfathered by the health care law. My insurer hasn’t covered preventive care and is using this “grandfather” excuse to avoid paying for preventive-care visits and tests. Can my insurer keep doing that?

The health care law did exclude “grandfathered” policies from certain provisions, including the preventive-care requirements. Grandfathered policies are group or individual policies that have not changed their coverage or out-of-pocket costs substantially since the health care law was passed on March 23, 2010. To qualify for this status, the policies cannot have significantly raised co-payment rates or the percentage of expenses the employee has to cover or lowered the employer contributions to premiums, and they cannot have raised deductibles significantly or tightened the annual limit on the insurer’s coverage. Plans that make any of those changes lose their grandfathered status and must provide some additional coverage. For more information about the definition of a grandfathered plan, see the Keeping the Health Plan You Have factsheet.

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Kimberly Lankford
Contributing Editor, Kiplinger's Personal Finance

As the "Ask Kim" columnist for Kiplinger's Personal Finance, Lankford receives hundreds of personal finance questions from readers every month. She is the author of Rescue Your Financial Life (McGraw-Hill, 2003), The Insurance Maze: How You Can Save Money on Insurance -- and Still Get the Coverage You Need (Kaplan, 2006), Kiplinger's Ask Kim for Money Smart Solutions (Kaplan, 2007) and The Kiplinger/BBB Personal Finance Guide for Military Families. She is frequently featured as a financial expert on television and radio, including NBC's Today Show, CNN, CNBC and National Public Radio.