Essential Benefits under the ACA can have which restriction?

Essential Benefits under the ACA can have which restriction?

• A. Dollar amount maximums can be included
• B. Visit maximums can be included
• C. No maximums are allowed
• D. Visit maximums can be included but dollar maximums are prohibited

Answer: (B)

The important idea here is that essential benefits under the ACA cannot be capped by a dollar amount. Plans may, however, set limits on how many times you can use a specific service in a given period. That means you could have a limit on the number of visits for certain benefits (a visit maximum), while there isn’t a dollar cap on the overall coverage for essential benefits. Think of it this way: the plan can say you’re covered for a certain number of physical therapy visits per year, but it can’t say you’ll only receive a fixed dollar amount total for all essential benefits. That’s why limiting visits is permissible andDollar caps on essential benefits are not.

The important idea here is that essential benefits under the ACA cannot be capped by a dollar amount. Plans may, however, set limits on how many times you can use a specific service in a given period. That means you could have a limit on the number of visits for certain benefits (a visit maximum), while there isn’t a dollar cap on the overall coverage for essential benefits.

Think of it this way: the plan can say you’re covered for a certain number of physical therapy visits per year, but it can’t say you’ll only receive a fixed dollar amount total for all essential benefits. That’s why limiting visits is permissible andDollar caps on essential benefits are not.