Autism and Health Care Coverage: What to Know

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In the late 90s, Autism was said to affect 1 in every 800 children. By 2005 the number had reached 1 in every 160 children. In 2013 the number has reached to 1 in every 80 children. There are several schools of thought as to why the number has risen so much. The bottom line is that no one really knows what causes it, why the number has gone up, and what the solution is for the illness. This has parents of children with Autism wondering how they will afford healthcare and what will happen financially if their children need ongoing or long term care for complications with Autism. If you are a parent of a child with Autism you may be wondering what you need to know about health care coverage and your child’s diagnosis.

Pre-Existing Conditions

If you have a child with Autism, you understand that in order to receive full medical coverage, your child must have been covered under insurance prior to the diagnosis. The issue of pre-existing conditions will be eliminated under new health care reforms. Currently, they are still in place and insurance companies can deny a child who has been pre-diagnosed with Autism. This leaves parents with children who were not covered under insurance at the time of their diagnosis wondering who they will pay for treatment. If you are in this situation, your options are fairly limited. You can pay out of pocket, register for government programs, and check into specialty grant programs that may allow your child to be seen by specialists and healthcare professionals for little to no cost.

Long Term Care

Long term care is a consideration parent of Autistic children should think about. Most of the children currently diagnosed with Autism may not have long term issues that require ongoing care. However, for children who are on the severe end of the Autism, long term care may be necessary. This care requires daily assisted living, care, and ongoing therapy. The problem is that certain long term care policies or major medical policies may not yet cover everything a severely low functioning Autistic child needs. In this case, parents will need to check with their insurance provider to determine the lifetime benefit of their coverage for Autism, what is not covered, and the options available to fund care that is not covered under their plan.

Options for Coverage and Consideration

If you are dealing with insurance coverage that will not cover your Autistic child, will only cover certain care options, or have limited coverage for various issues then you may want to consider other options. One of these options is a health savings account and another is gap insurance. Both programs offer several benefits including the ability to allow utilize as much of the major medical coverage as possible before using gap insurance or savings. This has benefited several families who may not have a low functioning child currently, but who may have complications later.