What is a Lifetime Maximum?

A lifetime maximum is the total amount an insurance plan will pay for covered healthcare services during your entire lifetime. Once this limit is reached, the insurance company stops paying for care, leaving you responsible for all costs. The Affordable Care Act prohibited lifetime maximums on essential health benefits for most plans, though some grandfathered plans and specific benefits like orthodontia may still have lifetime caps.

Why lifetime maximums matter

• Affects long-term coverage: Impacts individuals with chronic conditions requiring ongoing expensive care
• Creates financial risk: Can lead to medical bankruptcy if limits are reached during serious illness
• Influences plan selection: Important consideration when choosing insurance, especially for those with chronic conditions

How Solace can help

A Solace advocate can help you understand if your plan has any lifetime maximums, track your progress toward these limits, and explore alternative coverage options if you're approaching a cap. Advocates can also assist with navigating grandfathered plan rules and exceptions.

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