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Lifetime & Annual Limits

The current law prohibits health plans from putting annual or lifetime dollar limits on most benefits you receive.

Lifetime Limits

Under the current law, lifetime limits on most benefits are prohibited in any health plan or insurance policy. Previously, many 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

The current law bans annual dollar limits that all job-related plans and individual health insurance plans can put on most covered health benefits. Before the health care law, many 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 individual health insurance policies are not required to follow the rules on annual limits.

For More Information

Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on January 31, 2017
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