Lifetime Maximum

What Does Lifetime Maximum Mean?

A lifetime maximum is the limit on the total benefits a policyholder can receive from their health insurance company over the life of the policy. Once this limit is reached, the insurer is no longer obligated to pay for covered services.

Insuranceopedia Explains Lifetime Maximum

For example, an insurer may set a total lifetime dollar limit of $1 million on all health benefits or impose specific lifetime limits on certain benefits. However, the Affordable Care Act prohibits limits on many benefits. There are two exceptions: first, insurers can cap lifetime benefits for non-essential health care services; and second, grandfathered individual policies are not required to adhere to the regulations on annual limits.

Lifetime maximums also show up outside of human health coverage. Most pet insurance plans, for instance, cap how much they will pay out per year or over the pet’s lifetime, which is part of what pet insurance actually covers on paper versus in practice. A higher cap usually means more protection but a higher premium, so the size of the limit is one of the bigger drivers of the average cost of pet insurance.