Open Enrollment and ABA Therapy Coverage – What You Need to Know

The open enrollment period for health insurance plans under the Affordable Care Act (ACA), known as “Obamacare,” is going on now through January 31, 2016.

If you have an insurance plan (through an employer or elsewhere) that does not provide ABA therapy for your child with autism, now is the time to purchase a plan on the health insurance marketplace, also called health exchanges.

What Should You Do During Open Enrollment?

I Have Health Insurance Through My Employer

If you receive affordable health insurance through your employer that covers your child’s ABA therapy, or most of his ABA therapy, stay put.

If your employer does not pay for your child’s health insurance, or pays less than 50% of the cost, or does not provide adequate coverage of ABA and other autism therapies, you should consider shopping on the marketplace for a more affordable plan for your child.

open enrollment and aba therapy coverage

If you live in Ohio, you’re in luck.

Ohio is one of the 29 states that have passed laws that require:

  • ABA therapy to be included in health care plans sold on or off the exchange/marketplace that conform to the ACA.

You can stay on your insurance for yourself through your employer and purchase a separate policy for your child on the marketplace that includes ABA therapy coverage.

I Receive Medicaid
If you live in Ohio, you’re out of luck.

ABA therapy is not currently covered in Ohio through Medicaid.

To date, only 16 states offer ABA coverage for Medicaid families.

But don’t give up. You still have two options:

  1. You can purchase a separate plan on the marketplace that covers ABA therapy.
  2. You can apply for a waiver through Medicaid for ABA therapy coverage.

We have extensive experience with these two options and can help you find a plan on the marketplace or obtain Medicaid waivers for ABA therapy coverage.

Contact us today to discuss your options.

I Pay Out-of-Pocket for My Child’s ABA Therapy
If you pay out of pocket for your child’s ABA therapy, you still have options. We can help you discover funding sources and secure funding for your child’s ABA therapy.

Here’s a partial list of potential funding sources:

  • Autism scholarship from the Ohio Department of Education
  • Educational grants from your school district
  • Medicaid waiver of services
  • Help Me Grow (state-wide program that provides health and developmental services)
  • Other grants and scholarships

We have extensive experience and success in applying and securing funding from these, an other outside sources.

To get the ball rolling, contact us today.

I Don’t Have Health Insurance
If you don’t have health insurance, the law requires you to purchase insurance or else face a penalty.

You’re looking at $695 per adult and $347.50 for every child under 18. With a maximum of $2,085.

To keep this chunk of change in your pocket and out of Uncle Sam’s, you need to purchase a health insurance plan on the marketplace (deadline is January 31, 2016). Even if you think you can’t afford health insurance, most people qualify for some type of deduction through the Affordable Care Act.

Just make sure the health insurance plan you choose covers ABA therapy.

Climb Aboard
Whichever boat you’re in – employer insurance, Medicaid, out-of-pocket or no insurance – we can help.

We’ve navigated every situation.

We know what’s out there.

We know which health insurance plans cover ABA therapy.

Climb aboard.