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Uninsured Utahns
I worried that if I continued to have health problems, the lifetime cap would not cover me until I turn 65, another 5+ years from now!
Health Insurance Benefit Caps Endanger Retired
Utah Couple's Financial Security

In December 2008, Rochelle Wenger was hospitalized for several weeks with severe pancreatitis. When she returned home she needed home health care for her feeding tube, intravenous antibiotics and oxygen. In early January, she was hospitalized again for severe complications including heart failure, pneumonia, collapsed lungs, blood clots and multiple abdominal abscesses. After four surgeries and multiple procedures, she was released to an acute care center for three weeks. Rochelle finally came home in early March, still on intravenous antibiotics and oxygen.

After a brief hospital stay in July, Rochelle has stablized. Now she needs continuous, long-term follow-up care to manage her chronic medical conditions.

Rochelle's individual health insurance plan limits how much it will pay per year to $250,000; its lifetime maximum is $1 million. Last April, Rochelle hit her annual cap and has used half of her lifetime cap. Although she must continue to pay her $850 monthly premium, she is responsible for all billed medical costs incurred through the rest of the year. The billed amount is considerably more than the adjusted amount insurance pays, so it's as if she has no insuance at all. The result: even though Rochelle is technically "insured" she already has accrued $35,000 in medical debt.

Rochelle says, " I need another major surgery but essentially I have no health insurance, so I must postpone it until after the first of the year. In the long term, I worry that if I continue to have health problems, the lifetime cap will not cover me until I turn 65, another 5+ years from now!"


The Patient Protection and Affordable Care Act Prohibits Lifetime and Annual
Benefit Caps

The new health care reform law eliminates lifetime caps on essential benefits provided under group health plans. This prohibition on lifetime caps is effective September 23, 2010, six months after enactment of the bill. Additionally, the PPACA places restrictions on annual limits that may be imposed upon plan participants.