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The Affordable Care Act and Autism and Related Conditions

The Affordable Care Act contains important provisions for individuals with autism and related conditions and their families.  Under the new health care law:

  • Most health insurance plans are no longer allowed to deny, limit, exclude or charge more for coverage to anyone based on a pre-existing condition, including autism and related conditions.
  • All Marketplace health plans and most other private insurance plans must cover preventive services for children without charging a copayment or coinsurance. This includes autism screening for children at 18 and 24 months.
  • The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. The law also does away with annual dollar limits a health plan can place on most of your benefits. Prior to the Affordable Care Act, many plans set a dollar limit on what they would spend for covered benefits during the time individuals were enrolled in the plan, leaving individuals on the autism spectrum and their families to pay the cost of all care exceeding that limit.  
  • Young adults can remain covered under their parents’ insurance up to the age of 26.  Already, 3.1 million more young people have been insured through this provision of the new law.  For a young adult with autism or related conditions and their family, that means more flexibility, more options and greater piece of mind.
  • Individuals on the autism spectrum and families of children on the autism spectrum now have expanded access to affordable insurance options through the new Health Insurance Marketplace and expansion in Medicaid.
  • New health plans sold in the individual and small group markets, including the Marketplace, must cover “essential health benefits,” including hospitalizations, preventive services, and prescription drugs, to help ensure you have the coverage you need to stay healthy. Health insurers will also have annual out-of-pocket limits to protect families’ incomes against the high cost of health care services.