Concerns about new Charter Oak $100,000 annual cap

On Monday, Time magazine posted a story called “Low Health Insurance Caps Leave Patients Stranded.” The article exposes the real impact of caps as low as $1 million on individuals and families who face very serious illnesses. This issue is particularly important as the new state Charter Oak Health Plan rolls out. On the day it was launched we learned that the plan now includes a $100,000 annual cap on services, in addition to the $1 million lifetime cap.

According to the article, “Only 1% of employer-offered group plans – the largest health insurance segment – had caps as low as $1 million last year, according to a survey by the Henry J. Kaiser Family Foundation. But 22% had caps of less than $2 million, and some want to see all these relatively low maximums eliminated.”

The article outlines several cases – a leukemia patient, a child with a virus attacking her heart, another child in need of a heart transplant. In two of these cases, the families surpassed the caps within a year of diagnosis.

People with long-term conditions may not exhaust their benefits in one year, but can clearly see the cap approaching. The National Hemophilia Foundation told the reporter, “People with hemophilia can spend more than $200,000 a year just on drugs that prevent internal bleeding.” If they have any other medical needs, they could reach their cap even more quickly.

Sometimes people call the Consumer Health Action Network (888.873.4585) to get help with choosing an insurer. We always encourage people to weigh their options carefully and to check with the Office of the Healthcare Advocate (866.466.4446) to make sure that the plans they are considering are reputable. We are adding to our list: consider the lifetime coverage cap and any annual caps. Consumers should weigh the advantages and limitations of Charter Oak before signing up.
Connie Razza and Ellen Andrews