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Health Insurance Marketplaces and Autism

November 1, 2016: Open Enrollment started — first day to enroll, re-enroll, or change a 2017 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2017.
 
December 15, 2016: Last day to enroll in or change plans for coverage to start January 1, 2017.
 
January 1, 2017: 2017 coverage starts for those who enroll or change plans by December 15.

The Affordable Care Act was signed into law on March 23, 2010. The health reform law has affected millions of Americans, including the autism community, and introduced new provisions that affected the availability, adequacy, and affordability of health care including Health Insurance Marketplace Exchanges.Learn more here.

Depending on where you live, the coverage options on the Health Insurance Marketplace will differ. To help you better understand your options, try the tools below or review the Autism Speaks resources on understanding the Affordable Care Act and how it impacts individuals with autism and their families. 

Autism Speaks is proud of its commitment to securing meaningful health insurance coverage for all families affected by autism. We will continue continue to closely monitor implementation of the insurance laws and work with state and federal policymakers to strengthen the law in ways that improve access to care for the autism community. 

What does the Affordable Care Act mean for the autism community?

Because research shows that those with autism spectrum disorder face more serious coverage and benefit gaps than others, it is important to look at how provisions affect each individual.

Can the Affordable Care Act help you?

It depends on your unique circumstances, but the law includes a number of provisions that can 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

Questions? Call us at 888-288-4762 or en Español 888-772-9050, or email familyservices@autismspeaks.org.

COVERAGE TOOLS

 

 

ADDITIONAL LINKS AND RESOURCES

The following resources were prepared with the autism community in mind, and we hope you will find them helpful. 

 

HEALTH INSURANCE MARKETPLACE: HELPFUL RESOURCES

Want to access the Health Insurance Marketplace in your state? Or watch a quick video about how health reform works? Or learn what the American Academy of Pediatrics has to say about the Affordable Care Act? Autism Speaks highlights some valuable resources on health reform. More…

 

Coverage for ABA through the Health Insurance Marketplace

Applied Behavior Analysis (ABA) is an Essential Health Benefit and required to be covered in Marketplace plans in some states. More here.

 

THE ACA: FACT SHEETS

Health insurance is complicated, and Autism Speaks wants to help you make sense of new changes under health reform. We have developed a series of fact sheets that provide factual information about some of the law’s most significant reforms and how they might affect you. More…