8 Things to Know About the Affordable Care Act and Autism

Eileen Bailey Health Guide
  • With the advent of the Affordable Care Act (ACA), also known as Obamacare, more people have access to health insurance. But what does this mean to you - if you have autism - or your children? Will treatments you receive for autism be covered? Will you be turned down for insurance or given a higher rate? The following are 10 things you should know about the ACA and autism:

    You can no longer be turned down for insurance for a preexisting condition under most health insurance plans. This includes autism. Previously, insurance companies could deny health insurance to someone who had a health condition requiring ongoing care. This is no longer true. Insurers must offer you coverage, despite ongoing health conditions, and they cannot charge you higher rates because of your health history (rates can be adjusted for age, place of residence and smoking.)

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    All health insurance plans offered through the health insurance marketplace must cover preventive services for children without a copayment or deductible. This includes autism screening at 18 and 24 months old. Most private insurance plans must also cover these types of services. Plans must cover a minimum set of “essential health benefits” including behavioral health treatment.

    There is no longer a lifetime dollar limit on health insurance benefits. In the past, insurance companies could cap your benefits, meaning that if you reached the limit, you would no longer receive any health insurance. With the ACA, insurance companies cannot place these limits on policies. That means if you require extensive care, the insurance company must continue to pay for covered services.

    There must be a cap for individual and family out-of-pocket expenses. This includes deductibles and copayments. Once your family has reached the cap, your health insurance will pay expenses at 100 percent.

    You can continue to keep your children on your plan, up to the age of 26. This age used to be 22, the age when children typically graduated from college. Today, your child can continue to be covered on your health plan until he or she turns 26.

    More people have access to health insurance for themselves and their families. Along with the ACA, there has been Medicaid expansion. This means families who were not previously eligible for Medicaid assistance may be eligible now.

    Health insurance plans sold through the marketplace and in small group markets must provide coverage for “essential health benefits.” These include hospitalizations, preventive care and preventive care.

    In July 2014, the federal government clarified that Medicaid plans must cover “medically necessary diagnostic and treatment services” to children with autism. This includes speech and occupational therapy, personal care services and medical equipment. This can also include applied behavior analysis when deemed necessary.

    Families who meet financial eligibility will receive subsidies to help them pay for health insurance or reduce out-of-pocket expenses. Visit healtcare.gov or call

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    Open enrollment in the health insurance marketplaces runs this year from November 15, 2015 until February 15, 2015. Outside of those dates, you must show a major life change, such as losing a job and therefore losing health insurance, to qualify for health plans through the marketplace. Visit healthcare.gov or call 1-800-318-2596 for more information.

Published On: December 02, 2014