Private Health Insurance Resources for Young Autistic Adults


Private Health Insurance Resources for Young Autistic Adults

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Having private health insurance for your son or daughter after 18 years of age may prove to be more advantageous financially than the government insurance Medicaid.  Parents have the option of keeping their private health insurance as the primary health insurance for their young adult and Medicaid as the secondary.  The Affordable Care Act of 2010 states that private health insurance plans are required to allow parents to keep their dependent children on the family health insurance plan until the child turns 26 or works at a job that offers employer-sponsored insurance.

Parents will often ask which insurance company has the best health care plan for the child with autism.  Comparison shopping is always the best way to answer this question, but getting a PPO plan from any insurance company will always provide the most coverage especially for out-of-network doctors or specialists.  This definitely gives you an advantage over HMOs or Medicaid which are much more limited in their coverage.  Also, insurance plans are beginning to offer free preventative health care, no longer put a lifetime cap on the amount of care they will cover, will not cancel your coverage over a mistake in the paperwork and as of 2014 no one can be denied insurance due to a pre-existing condition.  However, careful review of private health insurance policies is advisable because some companies allow continued coverage if the child is a full time student or if the adult child is disabled and the parents continue to provide 50% or more of the adult child’s support and maintenance.  However, if your adult child is receiving SSI benefits some aspects of SSI payments are based on whether or not the young adult is claimed as a dependent by his or her parents.

In addition, the Autism Insurance Reform Act has passed legislation in certain states to eliminate discrimination on the basis of the autism diagnosis code ICD-9 299.00.  If your state has not passed this legislation, then there is a Supreme Court ruling that took place on May 7, 1991 «Kunin vs. Benefit National Life» in California that states;»… autism is not a mental illness under the applicable insurance policy, and therefore benefits are greater than the limitation set forth in the policy».  Any parents whose insurance claims for autism treatment are being denied or limited because of «mental illness» can refer to this Supreme Court Ruling which is approved nationwide.  Documents can be acquired from the Autism Research Institute.

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Related Sites

On the Road to Autism Insurance Reform: Already a Great Year
Description:  Autism Speaks blogs their endeavors with autism insurance.

Autism Insurance Reform Act
Description:  Frequently asked questions about the State Autism Insurance Reform Laws.

Description:  Considers certain procedures and services medically necessary for assessment and treatment of autism and other pervasive developmental disorders (PDD).

Blue Cross Blue Shield: Autism Coverage FAQ
Description:  Of Michigan or Blue Care Network plan has the autism benefit, this gives information and answers you may find helpful.

Health and Human Services (HHS)
Description:  Health insurance guidance and services through HHS are presented.

Affordable Care Act of 2010
Description:  What Autism families need to know.

Insurance Coverage for ABA Autism Benefits
Description:  This site gives you the state statutes specifically requiring insurance coverage for autism.

Autism Health Insurance Project
Description:  This site covers all the issues pertaining to health insurance and autism.

The Affordable Care Act: What Autism Families Need to Know
Description:  Find out what the Affordable Care Act means and which states cover autism treatments.


How Insurance Companies Turned Your Child’s Autism into a Mental Health Crisis by Travis Breeding
Description:  Written by an adult with autism, this book explains how insurance companies view autism as a mental disorder rather than a social one. The author details how to become an advocate for the special social needs of your child. This book brings a better understanding of autism to new parents. Also, this book comes with an autism guide for advanced parents dealing with several significant social concerns.

Autism Transition Handbook by Devereux
Description:  This section of the handbook talks about health coverage for young adults with autism 21 years of age and older.


Health Insurance Options for Children with Autism Spectrum Disorders
Description:  Boston University School of Public Health’s presentation on health insurance and children with ASD.

Private Health Insurance Coverage for Autism Spectrum Disorders
Description:  Autism Speaks slide presentation to the Interagency Autism Coordination Committee.

An 8 Step Guide to Insurance Coverage for Autism
Description:  Eight essential steps for autism health insurance autism coverage.

For Autistic Adults, Coverage Options are Scarce
Description:  This article talks about the health coverage reality for parents with young adults after 21.

Parent Forums/Blogs

Some forums require you to sign in to Yahoo or Facebook to locate forum names.

Forum/Blog Name:  Insurance Coverage for ABA Autism Benefits
Description:  This blog provides information for families about the Affordable Care Act which includes important stipulations regarding insurance coverage for individuals with autism.

Forum/Blog Name:  Friendship Circle Special Needs Resource Blog
Description:  This is an 8 step guide to insurance coverage specific for autism. It helps the reader to understand how to read a policy, discover exclusions and take action if problems with your child’s coverage are encountered.

Forum/Blog Name:  Coverage for Autism Treatment Varies by State
Description:  ABA coverage is not provided in every state and still varies depending on the state. This blog provides further information regarding private health insurance coverage in individual states.