ACA Facts: Lifetime and Annual Limits on Coverage

March 6, 2013

Lifetime and Annual Limits
The ACA prohibits all insurers from placing lifetime limits (a dollar limit on what they would spend for your covered benefits during the entire time you are enrolled in that plan) on most benefits, including ambulatory and emergency services; mental health and substance use disorder services; rehabilitative and habilitative services and devices; laboratory services; hospitalization; prescription drugs; and preventive and wellness services and chronic disease management.  The ACA also places restrictions on annual limits (a dollar limit on what insurers would spend for your covered benefits during a year) until 2014, at which time annual limits will be prohibited.  However, "grandfathered" health plans - in this case, an individual health insurance policy (not obtained through an employer) that was issued on or before March 23, 2010 - do not have to follow the rules on annual limits.