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ACA: Basics

12 Days of “Gifts” from the Affordable Care Act – Gift Five: Increased ACCOUNTABILITY in the Health Care System

In the spirit of this holiday season, the Wisconsin Alliance for Women’s Health invites you to share in a series of blog posts, each containing a special “gift” from health care reform. Some have already been implemented and some are gifts still to come; but all are very important improvements to our healthcare system.


Yesterday, we discussed how the Affordable Care Act (ACA) gives women and their families more accountability from insurance companies by ensuring that their premium dollars are being spent on their health care, and ensuring that coverage isn’t dropped when you need it most.

Today, we are celebrating another gift of accountability –companies can no longer put lifetime limits or “unreasonable” annual limits on the amount of medical care they will cover. Before the ACA, when women or their families had high-cost medical conditions, like cancer, a disability, or a chronic condition like diabetes, they could have found themselves in an impossible position when hitting their limit. This meant that over the course of a lifetime, or year (for annual limits), the cost of covered benefits exceeded a set limit by your insurance company, and the insured individual would have to pay out of pocket for all additional care that year – or for the rest of their lives. This practiceobviouslycaused major medical debt for women facing high-cost disease treatment, like for ovarian cancer.

Now, lifetime limits are banned. And there is a phase out of annual limits. By 2014, plans will no longer be able to have annual limits on coverage. In the meantime, these plans cannot set an annual limit lower than:

  • $750,000: for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011.
  • $1.25 million: for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012.
  • $2 million: for a plan year or policy year starting on or after September 23, 2012 but before January 1, 2014.

This gift is one we hope women don’t need – but one that we are glad to have now. The threat of major medical debt on top of a needed medical care is one no family should have to face.

Tomorrow, we will discuss gifts from health care reform regarding Medicare and Medicaid.


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