Affordable Care Act eliminates annual and lifetime dollar limits

The Patient Protection and Affordable Care Act requires insurance companies to drop lifetime dollar limits on health benefits.

How many of us have heard stories about people who have gone without needed health care because of concerns about lifetime limits of coverage? Maybe it has even happened to you. That unhealthy scenario will no longer be necessary since the Supreme Court, in a 5-4 decision, has upheld the majority of the provisions of the Patient Protection and Affordable Care Act (ACA) of 2010.

The Affordable Care Act requires insurance companies to drop lifetime dollar limits on health benefits. This new requirement also restricts annual dollar limits currently and completely bans them in 2014.

This part of the ACA lessens the burden for many individuals and families who are experiencing chronic health conditions. In the past, people with chronic health conditions often put off or went without recommended health treatment in order to avoid lifetime limits. According to Michigan statistics, 3,547,000 citizens, including 1,315,000 women and 977,000 children in Michigan no longer have to be concerned about coverage for long-term or lifetime conditions.

According to AARP, there are currently 100 million people who have health insurance benefits with lifetime limits. Ten percent of cancer patients surveyed by AARP said that they have reached their lifetime limit and their insurance companies no longer covered their health care needs.

The elimination of annual and lifetime limits applies to employer and individual health plans, but only for what have been called “essential benefits:”

     “ Essential health benefits must include items and services within at least the following 10 categories:
     ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental
     health and substance use disorder services, including behavioral health treatment; prescription drugs;
     rehabilitative and habilitative services and devices; laboratory services; preventive and wellness
     services and chronic disease management; and pediatric services, including oral and vision care.”

For more information on the ban on lifetime and annual dollar limits for health benefits, see “Annual Limits Policy: Protecting Consumers, Maintaining Options and Building the Bridge to 2014.”

To read more about the White House viewpoint, see the fact sheet “The Affordable Care Act: Secure Health Coverage for the Middle Class.”

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