What distinguishes non-grandfathered plans from grandfathered plans?

Non-grandfathered plans are distinguished from grandfathered plans primarily by their compliance with the Affordable Care Act (ACA) requirements. When the ACA was enacted, it allowed existing health plans to maintain their grandfathered status as long as they did not make significant changes to their coverage or cost structure. This means that grandfathered plans do not have to adhere to certain regulations imposed by the ACA, such as providing specific essential health benefits or adhering to certain cost-sharing limits.

In contrast, non-grandfathered plans must comply with all ACA regulations, including coverage for essential health benefits, limits on out-of-pocket costs, and mandatory preventive services without cost-sharing. Therefore, the key distinction lies in whether or not the plan is required to meet these ACA standards, making compliance a critical factor in differentiating between the two types of plans.

The other options, such as the age of the plan or the number of covered individuals, do not inherently dictate whether a plan is grandfathered or non-grandfathered. Similarly, provider networks can vary widely across both types of plans and are not a defining feature of their compliance status. Therefore, compliance with ACA requirements is the most accurate way to differentiate between non-grandfathered and grandfathered plans.