By Cecily Ruttenberg
Shopping for health insurance holds little of the same appeal as say, shopping for new shoes. But for parents of children with autism, the payoff could mean obtaining therapies that help their children make eye contact, communicate and dramatically improve their lives.
Despite the government shutdown, Affordable Care Act health insurance marketplaces are now open for business. If your child with autism is not receiving the therapies you believe he or she needs, read on to understand your options.
Employer-Sponsored Health Plans
PUBLIC BENEFIT INSURANCE
Beginning in 2014, Medicaid eligibility will be expanded to anyone with an income less than 133 percent of the Federal Poverty Level, or $31,322 (family of four). Eligibility is even higher for children. Unfortunately, at the present time in most states, Medicaid is not providing ABA therapy to beneficiaries. Autism advocacy groups are continuing to lobby government officials as Medicaid is the single largest funder of medical care for children with autism, and intensive intervention is known to improve functioning in those who receive it.
PRIVATE PAY INSURANCE
If you pay out-of-pocket for a private health insurance plan, check the exchange for a better deal, particularly if your current policy does not cover ABA and you live in one of the 24 states plus Washington D.C. that has agreed to offer this therapy as an essential benefit. If you earn less than 400% of the Federal Poverty Level you may qualify for a subsidized plan.
If you do not have health insurance, the law requires you to purchase insurance or else face a penalty. The penalty is small the first year (1% of annual income or $95-per-person), but increases. The good news is that if you earn less than 400% of the FPL, you may qualify for a subsidized plan.
Cecily Ruttenberg is communications director for the Autism Health Insurance Project, a nonprofit organization that helps families and providers secure insurance coverage for interventions related to autism and similar conditions. Visit www.autismhealthinsurance.org/aca for more information on the Affordable Care Act and autism.
Image: Portrait of a family sitting on sofa together via Shutterstock.