Obamacare News Blog

ObamaCare: No Annual or Lifetime Limits

There are a lot of consumer based benefits of the new Healthcare Exchange beginning January 2014. For the new “metal” plans, ranked from lowest monthly premium to highest, Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan, they must all offer the same set of ObamaCare essential benefits, all persons are offered guaranteed issuance with the Exchange, and depending on plan and income there are federal premium subsidies and federal cost-sharing subsidies. It has also been released that lifetime limits and annual limits will be a thing of the past as of January 1, 2014.


Annual Limits
The amount your insurance can cap you for spending for one year.

Lifetime Limits
The amount your insurance can cap you at a for your covered benefits during the entire time you were enrolled in that plan

New Law About Health Insurance Limits

  • Lifetime limits on most benefits are prohibited in any health plan or insurance policy issued or renewed on or after September 23, 2010.
  • $750,000: for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011.
  • $1.25 million: for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012.
  • $2 million: for a plan year or policy year starting on or after September 23, 2012 but before January 1, 2014.
  • No annual dollar limits are allowed on most covered benefits beginning January 1, 2014.
  • Important Facts About Limits

  • An annual dollar limit and a lifetime dollar limit does not count for spending for health care services that are not considered “essential.”
  • If the new annual rules apply to your plan, they will affect you as soon as you begin a new plan year or policy year on or after September 23, 2010.
  • If you have a “grandfathered” individual health insurance policy, your health plan is not required to follow the new rules on annual limits. (A grandfathered individual health insurance policy was issued on or before March 23, 2010, is an individual or family plan, and not purchased through your employer.) If you’re not sure whether your plan is grandfathered call 800-930-7956.
  • The ban on lifetime dollar limits for most covered benefits applies to every health plan — whether you buy coverage for yourself or your family, or you receive coverage through your employer.
  • Some plans may be eligible for a waiver from the rules concerning annual dollar limits, if complying with the limit would mean a significant decrease in your benefits coverage or a significant increase in your premiums.

  • Further Questions:
    If you have further questions about your current health insurance plan or the new Healthcare Exchange plans contact Medicoverage.

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