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ACA Updates and Research

As a parent of a young adult with autism and leader of an applied behavior analysis (ABA) therapy center focused on autism, I know firsthand about the challenges in finding appropriate and affordable insurance coverage to support special needs children. As details of the Affordable Care Act (ACA) continue to unfold, there are still many more questions than answers. Regardless, all parents need to have coverage in place by Jan. 1, 2014. That’s about 90 days away. With more than an estimated 100,000 Indiana families affected by autism – many of whom rely on health coverage to fund services for their children – it is important to start researching now to ensure understanding of the new health insurance marketplace and the best options for your special needs family.

As I work in the field of special needs, I am fortunate to be able to stay a step ahead of most parents with special needs children, but I am still challenged in this ever shifting landscape. I recently had the opportunity to work with professionals at Gregory & Appel Insurance, who helped our center to host an informational evening. It was standing room only.

As a member of the Indiana Autism Commission, I am exposed to information and insights that provide ins and outs for impending changes. I’ve already bookmarked key websites. Do the same. They are www.healthcare.gov and http://www.in.gov/aca/.

Employers, no matter the size, have to send letters to employees by Oct. 1 to explain key changes in the marketplace for employees. Did you get yours? If not, ask.

First the bad news: Many families affected by autism are currently enrolled with Indiana Comprehensive Health Insurance Association (ICHIA). It ends Dec. 31, 2013. There are options available. Researching now is critical.

Also critical to remember, insurance plans are not required to cover ABA therapy, a highly researched and widely accepted approach to teaching children with autism appropriate social, communication and life skills. Once families research the marketplace and narrow their plan-list to two or three options, contact each provider and ask if ABA is covered.

Now the good news: Medicaid, Medicare and military coverage will not change. These plans will remain the same on Jan. 1, 2014. New health insurance plans or insurance policies will cover preventive services without cost-sharing. Autism screening for children at 18 and 24 months is among those preventative services. For special needs families, particularly those affected by autism, this new health insurance marketplace could offer expanded options for essential services, including intensive behavioral therapy.

While change is hard, we are seeing a wide open marketplace with options. For families with coverage through an employer, remember the marketplace is good for additional coverage for families that need it. If parents choose this option, they would not be eligible for tax subsidies, but cannot be denied coverage due to preexisting conditions.

If you are not on an employer plan and are seeking coverage for yourself or your family, you can go through the individual marketplace operated by the federal government. A commercial marketplace, where an insurance agent helps you find coverage also is available, as are individual policies outside the exchange through a broker.

All insurance policies offer essential benefits, but monthly premiums differ. ACA requires insurers to cover essential health benefits, including laboratory services, prescription drugs and pediatric care, through four plan levels: bronze, gold, silver and platinum. Monthly premiums are based on the chosen plan.   

Reality is the details and options will continue to unfold in this new and shifting landscape. It is up to parents and families to engage now with their employers or insurance companies to determine the best option for their children. Remember, we only have 90 days to make the best decision on behalf of our children. Start now.

-By Mary Rosswurm, executive director Little Star Center