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What are chronic condition limits in health insurance?

Dr. Michael Roizen, MD
Internal Medicine
The healthcare reform legislation, the Affordable Care Act of 2010, virtually eliminated chronic condition limits, which in parts of the medical insurance policy’s fine print, denied you coverage. These limits used to exist, and they denied you coverage big time. As of right now, the only limit you may experience if you have a chronic condition is if you switch health plans. You may be subjected to a waiting period before your condition is covered. That’s because the Affordable Care Act has forbidden monetary limits on what insurance companies cover, and forbidden the denial of coverage because of chronic conditions.

A chronic condition in the medical world is a condition that can be managed but not cured, like allergies or asthma, as opposed to an acute condition, like appendicitis, that will resolve within a short period of time. How an insurance provider covers chronic conditions varies, so it is important to know your policy. Some insurance providers place limits on how long they will cover a chronic condition like asthma or allergies. Other providers determine when a condition, like cancer, changes from being acute to chronic, and how benefits will then change. Knowing your insurance policy is important when you are faced with the diagnosis of a chronic illness.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.