Marketplace Health Insurance
The Health Insurance Marketplace is an online portal that helps people find and enroll in a private health insurance plan.
The marketplace helps you
- Learn whether you are eligible for financial assistance
- Compare the cost and quality of new insurance plan options
- Enroll in coverage that meets your needs
Marketplace plans are generally available for purchase only during open enrollment periods unless you have encountered certain life changes listed on the Marketplace website. However, members of federally recognized tribes or ANCSA shareholders can enroll in a Marketplace plan any time.
Is coverage for Applied Behavior Analysis (ABA) available in health plans purchased through the Health Insurance Marketplace?
ABA is included in the “Essential Health Benefits” package and required to be covered in Marketplace plans in the following 33 States and the District of Columbia: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.
In these states, ABA also must be covered in non-grandfathered small group and individual plans sold outside the Marketplace.
ABA is not currently a covered benefit in Marketplace plans in Alabama, Florida, Georgia, Iowa, Kansas, Minnesota, Mississippi, North Carolina, Nebraska, Oklahoma, Pennsylvania, Rhode Island, South Carolina or South Dakota.
Can I purchase health insurance for my child through the Marketplace?
Yes. The Marketplace plans are required to sell child-only policies.
A child-only policy is an individual health plan available to children under age 21 with no parent or guardian covered on the same policy.
Financial assistance may also be available to help pay monthly premiums. Financial help will be determined based on the income of the parent who claims the child as a dependent on their federal tax return.
A child-only policy may be a good option
- If the child lives with grandparents who do not have private insurance because they are eligible for Medicare, and the child is not eligible for Medicaid or the Children’s Health Insurance Program.
- If the parents are divorced or live in different states.
- For families affected by autism whose job-based coverage does not include ABA.
If your child has access to an employer-sponsored plan, you will not be eligible for a discounted Marketplace plan.
You can still purchase a non-discounted child-only Marketplace plan. Some plans allow you to carry more than one policy while others do not.
Please check with your plan administrator if you are considering dual coverage for your child.
What is the difference between health insurance offered inside the Marketplace versus outside the Marketplace?
Health insurance plans for individuals and small employers must meet similar requirements inside and outside the Marketplace. These requirements include the coverage of essential health benefits, coverage of preexisting conditions, new rating requirements, and guaranteed availability and renewal.
Although coverage is similar inside and outside the Marketplace, you can only receive financial assistance if you shop through the Marketplace (e.g. lower cost premiums and reductions in out-of-pocket costs). You will not be eligible for lower costs if you purchase a plan outside the Marketplace.
Where can I get help using the Marketplace?
For questions about the Marketplaces or how coverage will work in your state, visit healthcare.gov or call the 24/7 hotline at 1-800-318-2596.
For additional options, such as a connection to a person in your state that can help you understand your options, visit https://www.healthcare.gov/contact-us/.
Autism Speaks is proud of our commitment to securing meaningful health insurance coverage for all families affected by autism.
We will continue to closely monitor the implementation of federal and state policies that regulate healthcare. We also work with state and federal policymakers to strengthen these policies in ways that improve access to care for the autism community.
To the best of our ability, this information is accurate and up to date, but it is up to the consumer to investigate fully before making any decisions regarding health care coverage.
Last Updated: November 2020