Content created by Assistant Secretary for Public Affairs (ASPA)
The health care law stops insurance companies from limiting yearly or lifetime coverage expenses for essential health benefits.
Lifetime Limits
Insurance companies can no longer set a dollar limit on what they spend on essential health benefits for your care during the entire time you’re enrolled in that plan. Previously, health plans set a lifetime limit — a dollar limit on what they would spend for your covered benefits during the entire time you were enrolled in that plan. You were required to pay the cost of all care exceeding those limits.
Annual Limits
Insurance companies can no longer set yearly dollar limits on what they spend for your coverage. Previously, health plans set an annual limit — a dollar limit on their yearly spending for your covered benefits. You were required to pay the cost of all care exceeding those limits.
Exceptions
- Plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not considered essential health benefits.
- Grandfathered plans are not required to follow the rules on annual limits.