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Health Care Reform:

Health Insurance & Affordable Care Act

Managing the Cost of a Chronic Condition: FAQ

Is there a limit on how much my health plan will pay toward caring for my chronic illness?

No. Whether you bought insurance on your own or you got it through your job, insurance companies can no longer set yearly or lifetime limits on how much they will pay toward covered essential benefits.


Will my insurance help pay for my chronic disease self-management program?

Self-management programs are covered by plans sold on the Marketplace, in the individual market, and through small employers. They are part of the essential health benefits the Affordable Care Act requires health plans to cover. Many health plans from large companies also help pay for these programs.

You may have a self-management program near you. To find one, see the National Council on Aging site and search for "chronic illness self map."

How can I find out exactly how much of my chronic illness treatments my plan covers?

To know for sure how much a plan covers, you can look at the plan's summary of benefits and coverage. This summary includes:

  • How much you'll have to pay for common medical services
  • What services aren't covered by your plan
  • Details about your prescription drug coverage
  • Whether your doctors participate with the plan’s network



How else does health reform help me if I have a chronic condition?

The law also put in place these protections:

  • You have the right to appeal if a plan denies coverage for your care.
  • You insurance cannot be denied or dropped because you are sick or because of a pre-existing condition.
  • You cannot be charged a higher premium if you are sick or have a chronic condition.


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