The impact of lifetime limits

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PricewaterhouseCoopers worked with the National Hemophilia Foundation on behalf of a coalition of advocacy organizations representing individual chronic diseases and disorders to conduct a study of lifetime limits under employer-sponsored medical plans. These include several high-cost conditions like hemophilia, Gaucher’s disease, immune deficiencies, certain cancers and others where annual costs in the hundreds of thousands of dollars or more are not unusual. Specifically, the study examines the prevalence of lifetime limits, the number of people affected by them, and the costs of increasing, or removing, lifetime limits from health plans.

The findings are based on public data, surveys of major insurers, and PwC actuarial modeling. Key findings from the report include:

• Approximately 55% of individuals with employer provided health insurance are subject to lifetime limits; the most common of which are $1 million and $2 million.
• It is estimated that approximately 20,000 to 25,000 people have exceeded limits with their current health insurance plans.
• Premiums would increase by less than one-half of one percent if limits were increased to $10 million.
• Removing limits would reduce Medicaid costs by $1 billion per year.