California health insurance  -  Understand California health coverage  -  Life time Max out of Pocket

Lifetime maximum benefits and your California health plan


We have some good news on the life time max front.

The new plans in California no longer have a life time max so although it's good to know (if you have some spare time and love insurance terminology), it's no longer a concern for legetimate carriers and plans.


This is an important part of your health plan and can quickly distinguish between a trustworthy health carrier and one that you may want to avoid.


If you see a life time max on a prospective plan, it might be a good reason to run the other way.


Let's take a look at the lifetime maximum in more detail to see why.


You can always run your quote here:

how to quote Covered California plans

First, what's the official definition of a Life Time Max:

Lifetime maximum benefit (sometimes referred as lifetime limit)
A dollar limit on how much the insurance company will pay in your lifetime. An insurer may, for example, cover up to $5 million over your lifetime. Above this they will pay nothing.

More detail on the lifetime maximum


So it is a fixed amount that the carrier will pay up to during the lifetime of an enrollee (even over multiple, spaced-out polices).

The lifetime maximum is usually per person in a family.


There is a distinction between HMO and PPO plans with most carriers.


Usually, PPO plans have a dollar amount such as the 5 or 6 million per person that was mentioned above.


For HMO plans, however, it is not uncommon to have an unlimited lifetime maximum.

Obviously, the higher the lifetime maximum, the better but truly catastrophic health conditions would be hard pressed to run even $1,000,000.

Open heart surgery probably runs about $100,000 so you can see that $5,000,000 is more than adequate.

At that point, you are just happy to be alive if you're even getting close to the maximum.


On the flip side, a $100,000 lifetime maximum is not a good option.


The whole point of health insurance (especially in today's medical climate), is to cap your risk or liabilities for a truly catastrophic situation.

If you have $250,000 of medical expenses and the lifetime maximum is $100,000, that leaves you out of pocket for the additional $150,000.


What's the point of having health insurance.


Granted, the odds of having these large bills are very low but invariably, it does happen each year to a percentage of all plan enrollees.


You can access the online application here:

How to apply for California obamacare

Why is the Max Out of Pocket Important


The maximum is the amount that the carrier pays out of pocket.This does not include the deductibles, copays, co-insurance, etc that you are contributing as well.


Your total medical bills may actually be much higher than the maximum when you take into account your out-of-pocket as well.

This lifetime maximum is a separate number from your annual maximum which caps YOUR exposure for in-network and covered benefits during a calendar year.


The two are mutually exclusive.

The annual max protects you while the lifetime max protects the carrier.

Again, this is very rare but in today's escalating cost environment and increasingly sophisticated technology landscape, it's not impossible to think that the maximum might be increased by the carriers going forward.


For now, it is just a good litmus test for a carrier's strength and stability and a distinguishing piece to help choose the right plan.


Other important concepts to help you understand your health insurance quote are:


You can run your California Plan Quote here to view rates and plans side by side from the major carriers...Free.

Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!

 Follow on social media

Covered Ca tax credits
Call 800-320-6269
Our Services are FREE to You!

Call to Enroll over the Phone in 15 Minutes

Enroll Covered Ca quickly online

Call 800-320-6269

Anthem Blue Cross California
Blue Shield of California under Covered California
Kaiser of California
Health Net of California
and more
Thousands of Californians
Hundreds of California Companies
Thousands of Californians
Hundreds of California Companies

from SC

"My sincere thanks for making a miracle happen- 2014 health insurance !! Many thanks for your expertise and advice yesterday !!"

from SD

"Thanks again for your help - I had absolutely no idea how to get this done when I got up this morning. You've made it remarkably easier than I expected. I hope you're not stuck at the office all night..."

from KV

"Anyway, I hope you got some time off this past week! Thank you again for your help and efforts on my behalf! I was very lucky to find you."

from EK

"I thank you very much for the time that you have invested in handling everything

from SR

"I truly appreciate the quick response and will think of you in the future if I need to make any changes to my insurance plans."

from VH

"You are awesome... takes a huge worry off my back, thank you for your kind. thanks for your time and kindness. !!"

from SA

"Wow, I can't thank you guys enough for your help...I couldn't imagine trying to tackle this on my own!"

from LM

"You are my new best friend. A HUGE thank you again.

Find out what customers are saying about our services

20 years of experience in the California health insurance market has taught us one thing...Competent and experienced guidance is Invaluable

We can quickly (very important) size up your health insurance needs and clearly explain the options available to you. Our focus is finding the most coverage at the best cost to you.

We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.

Call will be Pleasantly Surprised.  800-320-6269

Request a 10 Minute Health Plan Check-up

We'll quickly see if you have the best priced plan available and if you qualify for a tax credit

calhealth website

Our Services are FREE to You is a Goodacre Insurance Services Website

This website is owned and operated by Goodacre Insurance Services, which is solely responsible for its content. This site is not maintained by or associated with Covered California, and Covered California bears no responsibility for its content. The email address and phone numbers that appear throughout the site belong to Goodacre Insurance Services, and cannot be used to contact Covered California.