The fight for affordable health insurance coverage for autism treatment


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Nov 10 2014 - 12:40pm
Affordable health Insurance Coverage for Autism

In the world of autism getting a diagnosis is just the first step, sometimes the real fight starts after that when parents start looking for affordable health insurance coverage for autism.

Receiving affordable health insurance coverage for autism treatment with experimental therapies is a real fight for parents. In fact, some of these treatments have been used since the 1960s ,yet are still referred to as “experimental”. Before I get started I must say that this isn’t the reality for some very lucky parents, namely the individuals that live in the 36 states that currently have health insurance mandates for private insurances and Medicaid concerning autism. More specifically the lucky bunch that live in one of the 24 states that currently have mandates requiring Applied Behavior Analysis coverage for autistic children, whether that coverage includes a cap or not.

For those of us that have private insurance or Medicaid in the states that don’t currently require coverage for autism services it can feel almost hopeless at times. I’m no exclusion to this, in one of my more current blogs I dive deep into my families experience with our insurance company and their refusal to pay for services that would make all the difference for my child. I’m still fighting that fight. Shall we take a look at the different insurance types and their impact on the lives of the families of autistic children?

While I am sure that this health insurance option is wonderful for some individuals, for the ‘autism family’ it falls a little short. While it seems like a steal for family of 4 that makes 100-150% the federal poverty level [or $11,490-$17, 235 a year] considering the monthly cost is a mere $100; when you have to live on that little annually coming up with an extra $100 to cover insurance is near impossible. If you make 300%-350% the federal poverty level [or $70,650-$82,425 a year] it’ll cost a family of four $700 a month and they aren’t eligible for subsidies beyond a reduced premium. The premiums: a choice of 90/10, 80/20, 70/30, or 60/40 all with a deductible of $6,350 for an individual and $12,700 for a family.

When you add in the costs for the therapies this insurance doesn’t cover, including ABA therapy, and the costs for co-payments on medications which alone can total in the $100’s for some families it becomes impossible to pull off still. This insurance has the potential of leaving a family of an autistic child feeling hopeless seeing as though the average lifetime cost of raising an autistic child comes out to somewhere near $3.2 million dollars, that equals out to $40,000-$60,000 annually, or around $1000 a month [a lot of times out of pocket].

‘Obamacare’ isn’t all bad though.

Obamacare Requires Health Insurance Companies to Eventually:

  1. Pay for Job-based therapies
  2. Stop denying, excluding, or limiting coverage to anyone under 19 based on pre-existing conditions
  3. Cover autism screenings [though it specifies ages 18-24 months only]
  4. Stop imposing lifetime spending limits
  5. Allow individuals up to 26 to stay on their parent’s health insurance
  6. Have an out of pocket cap for families

Private Insurance Companies and Medicaid
Your experience in this category will heavily depend on where you live.


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The Chief Complaints among Parents in Regards to Private Insurance Companies and Medicaid are:


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