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Tuesday, April 16, 2013

Autism, Insurance, and the Affordable Care Act

Jessica Contrera writes at the Journal and Courier (Lafayette, IN) that the Indiana mandate has limits.  Like other mandates, it does not apply to self-insured plans (e.g., Purdue University).  It also does not apply to companies (e.g., Caterpillar) whose insurer is based out-of-state.
So for parents such as Clay and Danielle Sheese, who work for Caterpillar and Purdue, respectively, there is no chance of getting therapy for an autistic child without buying an additional insurance package.
When the Sheeses purchased an additional insurance plan for Jacob in 2011, they chose one that covered him individually.
Today, such child-only plans no longer exist.
“When it seemed to insurance companies that the Affordable Care Act would pass, they needed to cut costs. One of the ways they did that was to eliminate child-only plans,” said Mary Rosswurm, executive director of Little Star in Lafayette. “Now you have to buy a plan that covers both a child and a parent together.”
Dual-coverage plans are far more expensive than child-only. Rosswurm said some of the insurance plans used at Little Star cost parents up to $900 per month. With their child-only plan, the Sheeses pay just over $300 per month. The price differs for each family based on their insurance plans. Some pay for treatment via co-pays, others have no additional costs once they pay their monthly insurance bill.
For some families whose insurance does not cover autism, buying an additional private plan is out of the question, especially when one parent cares for the child instead of working a paid job.
Such families can apply for insurance provided by the Indiana Comprehensive Health Insurance Association. Essentially, ICHIA is state-provided insurance for people who private insurance companies consider to be “uninsurable.”
But this is where the Affordable Care Act comes into play again. Starting in 2014, insurance companies will no longer be permitted to deny coverage based on pre-existing medical conditions. That means there no longer will be “uninsurable” people, and therefore no longer a need for ICHIA to exist.
The program will end on Dec. 31, or as soon as the federal insurance program laid out in the Affordable Care Act begins.