This Tuesday, October 1, the Affordable Care Act will go into effect, allowing individuals to enroll in health insurance plans which would be implemented January 1. While many have debated the merits of such a law, the majority of Americans agree that it will benefit those with preexisting conditions and disabilities, including autism spectrum disorder (ASD).
Currently, the most common and effective treatment for ASD is applied behavior analysis (ABA) therapy, which 37 states, including California and New York, mandate that insurance companies cover. The cost of this form of therapy, which can be for up to 40 hours a week, can run families thousands of dollars a year. Oftentimes, families have to obtain funding from school districts or, in California, through regional centers, sometimes leading to a delay in services. However, coverage of ABA would continue under the Affordable Care Act.
While out-of-pocket costs, specifically premiums, may be higher due to the better benefits, families would get coverage under their insurance just as with any other illness. In addition, the law requires that insurance plans cover preventive autism screenings and assessments without a co-pay.
The Department of Health and Human Services details specifically how the Affordable Care Act would benefit those diagnosed with autism and their families:
- Job-based and new individual health insurance plans are no longer allowed to deny, limit, or exclude coverage to any child under age 19 based on a preexisting condition, including children on the autism spectrum. Starting in 2014, these protections will be extended to Americans of all ages.
- New health insurance plans or insurance policies must cover preventive services without cost-sharing, including autism screening for children at 18 and 24 months.
- Insurance companies will no longer be able to impose lifetime dollar limits on coverage. Prior to the Affordable Care Act, many plans set a dollar limit on what they would spend for covered benefits during the time individuals were enrolled in the plan, leaving individuals on the autism spectrum and their families to pay the cost of all care exceeding that limit. The law also restricts annual dollar limits and will prohibit them for new plans altogether starting in 2014.
- Young adults can remain covered under their parents’ insurance up to the age of 26. Already, 3.1 million more young people have been insured through this provision of the new law. For a young adult with autism or related conditions and their family, that means more flexibility, more options and greater piece of mind.
- Starting in 2014, individuals on the autism spectrum and families of children on the autism spectrum will have expanded access to affordable insurance options through new Health Insurance Marketplace and expansion in Medicaid.
- Also starting in 2014, new health plans sold in the individual and small group markets, including the Marketplace, will cover “essential health benefits” to help make sure that health insurance is comprehensive. Health insurers will also have annual out-of-pocket limits to protect families’ incomes against the high cost of health care services.
While it is difficult to forecast the effectiveness of such an ambitious law, it will certainly help alleviate the burden placed on already strained families, and provide easier access to early intervention treatments.
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