Obtaining Health Insurance for Autistic People

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April 23rd, 2009

One of the biggest problems for families with autistic children or adults is obtaining health insurance coverage. In my state, most individual carriers will issue an automatic decline for individuals on the autistic spectrum. Even if your family has group health insurance coverage, that plan may not want to cover all of the medical services an autistic individual may require to thrive.

Therapies for Birth Disorders

Many popular policies will only cover therapy in the case of a loss of function. Of course, this clause is buried in the small print, so many policy holders are not aware of this restriction. Since an autistic individual may have never developed age appropriate speech or physical abilities, the insurer can deny the claims because there was no loss of function. If you have the opportunity to sign up for new health insurance, make sure you pay attention to the way the policy handles therapy.

Mandated Autism Coverage

At least count, about half of the US states mandate coverage for autism. That means that about half of the US states do not. Of course, a group policy can not decline based on autism, but if your family needs individual health insurance this can be a huge problem.

Health Insurance for Autistic People Alternatives

State high risk pools

Laws differ by state, but in general, if a person has been declined for other health insurance and has no other options, the state high risk pool should cover them. Premiums are expensive though.

Children of families with moderate incomes

Who lack group health, may qualify for CHIPS (the federal children’s health insurance program). This program provides most medical services with very low copays and premiums.

Medicare for autistic individuals?

This doesn’t always work. Apparently Medicare, the federal program for disabled and senior citizens, will accept individuals with a low IQ. But some autistic people have normal or high IQ’s, and may not be disabled in the normal sense of the term. But they are still excluded from obtaining individual health insurance. In addition, Medicare may not provide all of the unique services an autistic person may require, but at least they would be covered for general health needs.

Group health insurance

Now group plans cannot deny an applicant, or applicant’s family, because of a pre-existing condition. If group health is available, this is probably a good option. On the other hand, a group plan may not cover all of the services that an autistic person needs.

Two Problems with Covering Autistic People

You must understand that there are two issues here, and not just one. The first problem involves obtaining general health insurance for autistic people who may be declined by private health insurance. Even with general health insurance coverage, it may be tough to find coverage for autism specific treatments like physical and speech therapy. Contact our insurance merchant for a free online quote.