Can health insurance companies in Colorado impose annual limits on essential health benefits?

In Colorado, as well as under federal law established by the Affordable Care Act (ACA), health insurance companies are prohibited from imposing annual limits on essential health benefits. This foundational regulation was put in place to ensure that all individuals have access to necessary medical services without facing caps that could lead to financial hardship or lack of access to care.

The essential health benefits include a variety of categories such as emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, and preventive services, among others. By eliminating annual limits, the intent is to provide comprehensive coverage, ensuring that individuals can receive the necessary care throughout the year without the risk of their coverage being exhausted.

While the ACA allows some flexibility regarding non-essential benefits, the essential health benefits must remain unlimited to safeguard patient access and care continuity. This policy reflects a broader commitment to health equity and consumer protection in the healthcare framework of Colorado and the U.S.