Under the Affordable Care Act, how can a grandfathered health plan lose its status?

A grandfathered health plan is one that existed before the Affordable Care Act (ACA) was enacted and meets certain criteria that allow it to avoid some of the ACA's mandates. However, to maintain grandparented status, specific conditions must be adhered to.

When an insurer significantly raises co-insurance charges, deductibles, or co-payment charges, it can be seen as a substantial modification of benefits or coverage. This action indicates a significant change to the coverage terms, which is one of the key actions that can cause a grandfathered plan to lose its status. The ACA was designed to protect certain consumer benefits, and substantial changes to cost-sharing mechanisms are considered a departure from the plan’s original terms, therefore invalidating its grandfathered status.

Other factors listed in the options, such as stopping coverage, changing the provider network, or merging with another insurance company, do not inherently result in losing grandfathered status as per the regulations outlined by the ACA. They may change the plan or the availability of the plan but do not directly affect the structural integrity of the coverage in a way defined by the ACA that leads to the loss of grandfathered status.