Health coverage rights and protections

Ending Lifetime & Yearly Limits

The health care law stops insurance companies from limiting yearly or lifetime coverage expenses for essential health benefits.

Lifetime Limits

Insurance companies can’t 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.

Yearly Limits

Insurance companies can’t set a yearly dollar limit on what they spend for your coverage. This is true for plan years or policy years starting January 1, 2014 or later.

Does this apply to my plan?

It depends. Protections against lifetime limits on coverage apply to all health plans, including grandfathered plans, whether you get coverage through your employer or buy it yourself.

Protections against annual limits apply to most health plans, but they don’t apply to grandfathered individual health plans. Check your plan’s materials to find out if your health plan is grandfathered.

Are there any exceptions I should know about?

Yes. Insurance companies can still put a yearly dollar limit and a lifetime dollar limit on spending for health care services that are not considered essential health benefits.