More Insured Patients Reach Lifetime Coverage Limits

A "small but growing" number of U.S. residents with "costly chronic illnesses" are reaching the "lifetime benefits cap of $1 million or more that is a standard part of many insurance policies," the Washington Post reports.

People who reach the limits can face health care bills of "hundreds of thousands of dollars or more, prompting their families to seek help from the government, or to scramble to change jobs or even divorce for no other reason that to qualify for new health insurance," according to the Post.

The Post reports that the "predicament of those who burst through lifetime insurance caps is largely ignored in the debate about overhauling the U.S. health care system," which mainly focuses on expanding access to care for the uninsured. Some advocates for the chronically ill are planning lobbying efforts aimed at persuading lawmakers to require health insurers to increase the lifetime benefits limit to as high as $10 million.

According to advocates, the amount of many caps has not increased in decades or has not kept pace with the rate of health care inflation, and the high cost of new treatments and therapies makes it more likely that some people will reach their benefits limit.

Glenn Mones -- vice president for public policy at the National Hemophilia Foundation, which is launching a lobbying effort to push increased caps -- said, "The majority of people who have private insurance don't have super-low caps, but there are enough of them for it to be a problem. Where you really have a problem is the people who have the $1 million and $2 million caps, especially if they develop complications."

According to a survey by the Kaiser Family Foundation and the Health Research & Education Trust, 55% of employees with employer-sponsored coverage had a lifetime limit in 2007, including 23% with a cap of less than $2 million, compared with about 50% who faced caps in 2004.

Mohit Ghose, a spokesperson for America's Health Insurance Plans, said increasing the caps will not address the larger problem of ensuring that people get the most value from every health care dollar spent. He said, "What we are saying is that there's got to be a better way of helping those with the highest health care costs. And consequently, we need to be addressing those costs very directly -- not just the fact that people are incurring those costs, but why are those costs so high?" (Lee, Washington Post, 1/27).