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A trusted independent health insurance guide since 1994.
The maximum benefit dollar limit refers to the maximum amount of money that an insurance company (or self-insured company) will pay for claims within a specific time period.
Maximum benefit dollar limits used to be commonplace, but the Affordable Care Act eliminated them in most cases for essential health benefits (grandfathered plans can still have annual maximum benefit dollar limits, but not lifetime limits; all other plans are prohibited from having lifetime or annual maximum benefit dollar limits on any essential health benefits).
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As of April 2012, lifetime benefit maximums on essential health benefits were prohibited on all new and renewing student health plans. But self-insured student health plans do not have to conform to these rules.
All new individual and small-group plans have covered essential health benefits (EHBs) since 2014, and there cannot be dollar limits on the lifetime or annual benefit maximums for these benefits.
Colorado family's struggle with monumental health expenses will no longer include battle with insurance carriers over lifetime caps
Allowing insurers to impose benefit limits might help lower premiums, but would taxpayers, patients, and families be left holding the bag?