The Navigator Resource Guide has not been updated for 2025 Open Enrollment. For more current information please visit:
cms.gov/marketplace/in-person-assisters/information-partners.
QUESTION

My employer plan has an annual limit on my benefits. Is that still allowed?

Post enrollment issues | Employer-Sponsored Coverage |
ANSWER

Plans required to comply with the Affordable Care Act's reforms cannot have annual or lifetime dollar limits on benefits that are considered essential health benefits. However, plans can apply annual limits to services that are not part of the essential health benefits, even if they are covered services. Plans are also allowed to impose non-dollar limits on benefits, such as visit limits. Check the details of your plan to see how the annual limit is applied in your coverage. Your Summary of Benefits and Coverage will provide that information. See also the Alternative Coverage section to learn more about plans that do not meet the Affordable Care Act’s requirements. (45 C.F.R. §§ 147.126147.200.)

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