Health Insurance Caps

[maddythebeagle]

I had read that some familys with sick kids are running up against the caps on medical insurance. What kind of caps are there for FIRE types purchasing their own insurance? and is this of concern to folks?

 

[Martha]

I think lifetime caps generally range from 1 to 3 million. Caps of a million are very common and often date back to the 1970s with no increases since then.

 

[Ginger]

Most of the PPO plans seem to have 'caps.' The HMO plans don't.

 

[Martha]

Some HMO plans also have lifetime caps. Don't know to what extent and if any particular state has limitations on lifetime caps for health insurance (PPO and HMO) plans in their state.

 

[Ginger]

The HMO plans don't seem to have a cap out here in Southern CA. Best to check fully. One major illness can run up that tab.

 

[MasterBlaster]

The HMOs don't have a maximum lifetime cap but they ALWAYS cap the amount of care that you can get. That's what HMO's are all about.

So to say that the HMOs don't have a cap is misleading

 

[Ginger]

I believe 'cap' refers to a money cap, and not the quality of care offered.
We can really start a huge discussion about the different HMO plans and if they deliver good care. A whole different ballgame.

 

[maddythebeagle]

I believe all of the plans offered through our work are capped at 1 million.

 

[TromboneAl]

.

 

[Martha]

Maddy, our PPO insurance through work has a two million dollar cap. We bought up to the bigger cap a couple of years ago. For a group plan, it really wasn't that expensive to increase the cap.

For individual plans, I don't have a feel for the pricing to get a plan with no maximum lifetime benefits or the cost differences based on different caps. It would be interesting to see whether anyone here shopped for individual insurance and compared costs of different maximum benefits.

HMOs haven't interested me much personally because you generally are stuck in a particular geographical area to use the HMO physicians etc.

 

[KB]

When I worked for a BC/BS plan, they would auto reinstate a certain dollar amount each year. At that time it was 100,000.00, and the average Cap was 1M. This would lower the amount that had been applied to the Cap. For those checking on Cap, check for annual auto reinstatement as well.