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PriceWaterhouseCoopers Study Demonstrates Need to Raise Lifetime Caps

Lifetime health insurance caps, which are frequently as low as $1 or $2 million, are a serious issue for people with hemophilia and other high-cost chronic conditions. The National Hemophilia Foundation (NHF) has been working with a broad range of patient groups, industry and others to address this problem by promoting federal legislation to raise lifetime caps initially to a minimum of $5 million and eventually to $10 million (click here to read more about the legislation). However, obstacles to advancing this legislation include a lack of data on the prevalence of these low caps, and the potential impact of raising them on insurance premiums and government spending.

Although PriceWaterhouseCoopers, one of the world’s largest accounting firms, studied this issue in the 1990s, that information is now out of date. That’s why NHF, acting on behalf of the coalition, hired PriceWaterhouseCoopers to conduct a new study of lifetime limits under employer-sponsored medical plans. 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 the firm’s actuarial modeling.

The study is now complete (click here to see the full report). It includes some important findings, including:

  • The most common lifetime limits are $1 million or $2 million. More than 20% of people covered by employer plans are subject to lifetime limits of $1 million; another 32% are subject to limits of $2 million or higher.

  • Increasing lifetime limits from $1 million to $5 million would increase premiums, on average, by 0.6% to 0.8% (approximately $3 per month for typical single plan, $8 per month for family plan).

  • If lifetime limits were increased to $10 million, PwC estimates that Medicaid programs would save more than $1 billion in 2010.

From these and other findings in the report, it is now clear that lifetime health insurance caps are a burden for many. The caps can be effectively addressed in a way that will provide the government with cost savings, while not significantly affecting insurance premiums. NHF and its coalition partners will use this data to help persuade our elected officials that now is the time to raise lifetime insurance caps.

Click Here to Take Action on Lifetime Caps



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