Lifetime Limits Elimination Helps Americans Struggling with Chronic Illness: News of the Day

As mentioned yesterday, a provision of the Affordable Care Act banning lifetime limits on health care coverage goes into effect next week, on September 23rd.

A lifetime limit on coverage is a cap on how much an insurer will pay for any one policy.  When medical bills exceed this cap, which is often the case when a person is diagnosed with a serious or chronic illness, insurers can stick the patient with the rest of the bill. Over 90% of individual health insurance policies have lifetime benefit limits, but such practices will be prohibited under the health reform law. A recent NPR piece explained this important change:

“Among the new provisions of the health law that take effect later this month is a ban on something most people don't even know they have — a lifetime limit on benefits covered by their health insurance.

“Starting late next week, new health plans or plans that are renewed, won't be able to cap the dollar amount of benefits they cover. No more yearly caps either, though those limits will be phased out over three years, disappearing entirely in 2014.

“The change apply even to health plans that don't have to abide by some new rules because they were ‘grandfathered’ under the health law.”
…

“Until now, many people with expensive chronic conditions simply considered it their lot in life to have to change jobs every couple of years in order to maintain coverage.

“Take Edward Burke, of Palm Harbor, Florida. Burke, who has hemophilia, and has ‘capped out,’ as those with chronic conditions call it, twice in the past seven years. ‘I would have capped out four or five times,’ he says, but for the fact that the industry he works in, home health care, had been going through a series of mergers and acquisitions. So every time his company was bought and changed names, he was lucky enough to start with new health insurance — and a new lifetime limit.

“Burke estimates he spends about $900,000 per year on factor VIII, which replaces a clotting factor he lacks. That makes chewing through a lifetime limit of even several million dollars a matter of when, not if.”

As the ban on lifetime limits goes into effect for health plan years beginning on or after September 23, 2010, people like Edward Burke will not have to struggle to maintain coverage any longer.