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:
- Job-based and new individual health insurance plans are no longer allowed to deny, limit, or exclude coverage to any child under age 19 based on a pre-existing condition, including children on the autism spectrum. Starting in 2014, these protections will be extended to Americans of all ages.
- New health insurance plans or insurance policies must cover preventive services without cost-sharing, including autism screening for children at 18 and 24 months.
- Insurance companies will no longer be able to impose lifetime dollar limits on coverage. 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. The law also restricts annual dollar limits and will prohibit them for new plans altogether starting in 2014.
- 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.
- Starting in 2014, individuals on the autism spectrum and families of children on the autism spectrum will have expanded access to affordable insurance options through new Health Insurance Marketplace and expansion in Medicaid.
- Also starting in 2014, new health plans sold in the individual and small group markets, including the Marketplace, will cover “essential health benefits” to help make sure that health insurance is comprehensive. Health insurers will also have annual out-of-pocket limits to protect families’ incomes against the high cost of health care services.