The ACA And The Autism Community

The Affordable Care Act – also known as health reform or “Obamacare” – has ushered in significant changes for millions of Americans, including individuals with autism and their families and caretakers. Why does health reform matter for the autism community? Because research shows that those with autism spectrum disorder face more serious coverage and benefit gaps than others. And existing coverage often does not meet families’ needs.

Will the Affordable Care Act help? It depends on your unique circumstances, but the law includes a number of provisions that may impact the autism community. These provisions include:

  • Coverage even if you or your child has a pre-existing condition, including a diagnosis of autism spectrum disorder
  • Coverage of a minimum set of “essential health benefits” – including behavioral health treatment, habilitative services, prescription drugs, and pediatric services 
  • Coverage with no lifetime or annual dollar caps on essential health benefits
  • The option for children to enroll on their parent’s insurance policy up to age 26
  • Guaranteed availability of child-only policies for children under age 21
  • Annual limits on out-of-pocket costs
  • Financial assistance for qualifying families to help pay monthly premiums or reduce out-of-pocket costs
  • Coverage of preventive services without cost-sharing (such as copays or deductibles), including autism screening for children at 18 and 24 months
  • Greater transparency in appealing a decision after your insurer denies a claim
  • Limits on discrimination based on race, color, national origin, sex, age, or disability, among other factors

For more on the Affordable Care Act and why health reform matters, be sure to check out our guide to the Affordable Care Act and the Autism Community. To learn more about the new law and how it affects your coverage, check out our fact sheets on the most significant reforms and things to consider when you shop for coverage.

  • For questions about the new Health Insurance Marketplaces or how coverage will work in your state, visit healthcare.gov or call the hotline (available 24/7) at 1-800-318-2596.
  • For additional options, such as live chat or a connection to a person in your state who can help you understand your options, see this information.
  • For questions about autism-related information, resources and opportunities, contact our Autism Response Team at familyservices@autismspeaks.org.