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Thursday, September 23, 2010

The ban on lifetime and annual limits can impact YOU!

It has been six months since the Patient Protection and Affordable Care Act (PPACA) passed.  We have made considerable progress with changes to the health insurance system.  Elimination of lifetime and annual limits is a significant change and huge victory for individuals living with bleeding disorders such as hemophilia, chronic conditions and costly medical and catastrophic illnesses. Lifetime and annual limits are monetary limits placed on health insurance policies.   Prior to the ban on lifetime and a phased-in ban on annual limits, a person who reached their lifetime or annual limit could be dropped by their insurer.

For a person living with hemophilia, a bleeding disorder in which a blood clotting protein is missing, the treatment and health care cost can be astronomical and range upwards of $1 million annually. With expensive treatment and health care cost a person with a chronic condition or catastrophic medical emergency could reach their lifetime limit within a matter of a few years and annual limit within the health plan’s year.  Subsequently, an individual or family left without insurance must find alternatives for health coverage such as Medicaid, utilize emergency rooms for care and treatment, or pay more in out-of-pocket costs.  The impact to individuals and families can be financially devastating.

On September 23, 2010 we no longer have to worry about lifetime limits on essential health benefits.  The PPACA prohibits lifetime limits from being imposed by group health plans, group health insurance coverage and individual health insurance coverage.  Restricted annual limits will continue to be imposed until January 1, 2014 on both new and grandfathered (existing) group plans.  Prior to 2014, new and grandfathered group plans may impose the following “restricted annual limits”:

  • For a plan year beginning on or after September 23, 2010, but before September 23, 2011 - $750,000.
  • For a plan year beginning on or after September 23, 2011, but before September 23, 2012 - $1, 250,000.
  • For a plan year beginning on or after September 23, 2012, but before January 1, 2014 - $2,000,000.

The elimination of lifetime caps and the phased-in restriction of annual limits is a victory for many families across the country.  Individuals with bleeding disorders such as hemophilia have been aware most of their lives of the high cost associated with bleeding disorders. Nonetheless, until all limits and caps are banned, it is important for ALL consumers to be aware that anyone can be impacted by monetary limits placed on health insurance plans.   ALL consumers should read and understand their health insurance plan, whether they have restrictive lifetime or annual limits and this important change brought on by the PPACA.  


This post was written by Kisa Carter of the Hemophilia Federation of America, a non-profit that champions the rights and protection of people with bleeding disorders.