TheAffordable Care Act(ACA, also known as Obamacare) ushered in numerous new health insurance regulations.
Only a small fraction of the population has individual/family coverage (i.e., self-purchased health plans).
However, these are the plans that tend to get the most attention when we talk about ACA compliance.
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However, the specifics of how the ACA regulates the coverage differ significantly.
These plans can be purchased in thehealth insurance exchange(Marketplace) ordirectly from a health insurance company.
Note thatsubsidiesare only available if the coverage is purchased in the exchange.
This is true regardless of where you’re buying your coverage.
(Colorado will switch to the 50-employee threshold starting in 2026.)
Most large employers choose toself-insureinstead of purchasing health coverage from an insurance company.
State rules can go beyond what the ACA requires, but they do not apply to self-insured plans.
These plans exist in the individual/family and small group markets in the majority of the states.
Grandfathered health plans exist in the individual/family, small group, and large group markets.
They are also generally exempt from subsequent federal regulations.
These fully exempt plans are not consideredminimum essential coverage.
Theres no longer a federal penalty for not having minimum essential coverage.
You may find one of these plans thats fairly robust in terms of benefits and consumer protections.
Summary
ACA-compliant health plans must follow rules established by the Affordable Care Act.
“ACA-compliance” is a broad term that applies differently to different types of health insurance.
KFF.Health insurance coverage of the total population.
HealthInsurance.org.Are you ready to offer small-group health insurance?
Colorado General Assembly.SB24-073, Maximum Number of Employees to Qualify as Small Employer.
Enacted May 1, 2024.
Word & Brown.Special Open Enrollment: Small Group Participation and Contribution Requirements Waived.
Oct. 30, 2024.
healthinsurance.org.Self-insured health plan.
HealthCare.gov.Health Insurance Rights and Protections: Grandfathered health insurance plans.
HealthCare.gov.Grandfathered health insurance plans.
Thompson Reuters.What Is the Difference Between a Grandfathered and a Grandmothered Health Plan?Aug.
