Health Overhaul Brings Ban On Lifetime Benefit Caps

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.

Karen Pollitz, head of an office at the Department of Health and Human Services to help consumers navigate overhaul, says it's a big change:

    "This is sort of the ultimate example of what insurance is for. We're buying protection against the financial ruin that comes with a very expensive medical condition or injury as well as assurances that we'll be able to connect to the care we need to get better. So when you hit the lifetime limit, you often lose access to the treatment, not to mention your house".

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.

But it's not just people who know they will have high medical bills who are at risk. "It could happen to any of us," says Pollitz, who said she had a friend who had twins born prematurely. "And before their first birthday, the father had hit the lifetime limit on his family's coverage because of all the health problems they had."

Even so, relatively few people are affected by the change. So HHS estimates that the added premium cost of making health plans eliminate lifetime limits is modest — adding about a half a percentage point to group health plans and three-quarters of a percentage point to individual policies.

But for people like Edward Burke, not to have to worry about "capping out," anymore, as he says, "is huge. It's just huge."


HectorSF

[eureka254]

Great info, Hector!  I didn't know that the new health care legislation provided this golden nugget.  All this is especially pertinent for patients with hep c who may encounter costly treatments or have to face transplantation.  

I know from experience about having to switch insurances in order not to max out -- I've had to do it twice in the last three years to prevent my husband's prescriptions from capping out the annual maximum -- and I've been fortunate enough to have the option to change policies, which I know many people do not.  Both insurances last year removed their caps, though, to my relief -- most likely in anticipation of the upcoming rules you outlined above.  

Thanks for the post, and as always, wishing you well and all the best. ~eureka

[child24angel]

Hi Hector, thanks for posting this information

I'm with Eureka on this ....wholeheartedly.

It does cost that much a year for hemophiliacs or more.
I know at least 50,000 per month or more.

I hope it helps every single disease there is in this sometimes
upside down world.

[nygirl7]

Wow that is some great information I hadn't known about at all. I agree wholeheartedly with eureka and angel 100%. Unless you've lived with someone in that boat it would never occur to you (as it never did to me). Wow.

[FlGuy]

The dirty little question....who pays?

[nygirl7]

FLG - I know I thought about that too.  

[desrt]

Required,
universal,
unlimited healthcare?

That's not a question of who pays, but of where do you find the resources. If our doctors worked 16 hour days and we devoted our entire economy to healthcare and meds production, I still don't know if we could achieve this.
Still, a noble goal and if you don't try you'll never know what the actual limits are.

[HectorSF]

How is it paid for?
This is the basic tenant of health care in the industrial world. By increasing the pool of the insured the cost evens out as most persons are healthy and do not use the cost they are paying into the system. I've been paying for health insurance for the past 30+ years, only seeing my doctor if a had a bad flu or something minor. Now that I need health care services all I am asking is for the insurance company to provide the services they are in business to provide. This is a business model that is used throughout the insurance business whether it is car insurance, life insurance, disaster insurance, etc. No rocket science needed. :)

Also without  going to far into it, under the new law, the insurance companies must use at least 80% of income from subscribers to provide health care services. Not overhead and perks. This may moderate some of the executive salaries such as my own insurance company's WellPoint CEO Angela Braly who received a 51% year-over-year pay increase, per an SEC filing on Friday. Ms. Braly’s overall compensation rose from $8.1 million in 2008 to $13.1 million in 2009.
Where do I sign up? How many of us have gotten a 50% raise?

How can we achieve this?
Most insurance companies have already implemented these provisions and  apparently few here on a forum concerning health issues are even aware of it.

For more information for people concerned about there coverage paying for the new STAT-C HCV treatments it might be helpful to follow the changes to the health care system as provisions are rolled out of over time.

Hectorsf

[willing]

>How is it paid for?
indeed, that's the question. The choices seem limited. Either  pay all your  own expenses - which means the very wealthy can afford health care and every one else can die early or hope for charity OR  distribute the costs so that   a  large and healthy majority pays for the costs (which need not include Angela Braly's bonuses)  of the much smaller group in need.

[can-do-man]

starting to sound like a political thread to me, and on the main page....... Hmmmmm

[FlGuy]

The search is on for that large and healthy (and wealthy) majority

[Emily_MHModerator]

We can leave this up if it doesn't get political.  If you can talk about this without politics, go for it.

Em

[desrt]

The silence is deafening.

http://www.msnbc.msn.com/id/39215770/ns/health-health_care

[eureka254]

Healthcare shouldn't be political, it should be universal -- but until it is, we do what we have to in a less than perfect system.  Years ago I had to make the difficult decision to abandon self-employment so that I could get affordable health care coverage.  Though it was a difficult decision and I don't regret it today, it's unfortunate that insurance coverage and premiums were (and are) such that they dictate major decisions about our careers and our families and our lives -- the status quo certainly is a long way from universal -- here's to hoping and praying that where we are is a step in the right direction.

[RobertBeWell]

"here's to hoping and praying that where we are is a step in the right direction. "

Amen. All 3000+ pages of it.

[child24angel]

We can only go forward with health care , sometimes
I wonder though.

[EyesofBlue55]

Got my letter from Blue Cross/Blue Shield just today! It states 'No more lifetime dollar limits on benefits" it also says if your coverage was previously cancelled because you reached the lifetime dollar limit under your plan,you have a one time special enrollment right under the law.I can also keep my  2 childern on until they are 26 yrs old.This is great-it will save them some money too !!!

[child24angel]

That is great news !

[streamline569]

Does anyone know how the new health care law will effect our co-pay. Mine are pretty hefty. Was just wondering