This is the fifth in a series of blog posts celebrating the benefits that the Affordable Care Act (ACA) provides to people with disabilities. For the full list of prior and upcoming blog posts, see Friday’s news item.
The ACA Prohibits Monetary Caps
In the first four blog posts of this series, we explain the important benefits that the ACA provides in requiring insurance companies to provide coverage to anyone who wants it, prohibits them from kicking people off of policies simply because they cost too much, prohibits them from charging more based on someone’s health and requires them to provide a benefits package which covers the vast majority of treatments that individuals would need. All of those protections would not mean anything if an insurance company would then be permitted to limit the amount of money which they spend on any one individual.
Prior to the ACA, insurance companies routinely would set annual and lifetime caps on how much they would spend on any one individual. Once an individual hit those caps, the insurance company would no longer cover any of the health care costs for that individual. There were stories of babies being born with serious health conditions that required that they stay in the NICU and they would exhaust their lifetime cap after they were only a few weeks old.
The ACA made it illegal for insurance companies to put these arbitrary dollar limits on how much they would pay to cover an individual in a year or over the course of their life. However, it should be noted that the prohibition only applies to monetary caps, not caps on services. For instance, an insurance company is still within their right to limit the number of therapy visits for which they will pay.
The ACA’s prohibition against annual and lifetime monetary caps is a necessary provision to ensure that an individual with complex medical needs need not worry about their benefits running out in any one year or over the course of their life. Individuals and families who have paid for health insurance need to know that coverage for needed medical treatment extends for their entire lifespan.
