Everything you need to know about open enrollment

The Affordable Care Act (ACA) - more commonly known as ObamaCare - was enacted by President Obama in 2010. It is considered the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. Critics raised concern about the cost of Obamacare. Some believe that the ACA will increase the cost to members while reducing funding for providers. Though we are still assessing the outcome of the ACA, some things have proven themselves to be beneficial. And the benefits are most apparent for the autism community.
The most useful aspect to the autism community is the expansive coverage of autism services. There are now many health insurance plans that cover all autism services. Plans even cover intensive services such as Applied Behavior Analysis (ABA). Sometimes businesses and employers provide these policies. Others can buy similar plans through the Health Marketplace (see below). And now, because of Open Enrollment and the Affordable Care Act, anyone can switch plans or carriers to find better coverage.

So, what do you need to know about Open Enrollment to navigate it? Below find information on health insurance plans that cover autism services. Additionally,when and how to sign up for these plans during Open Enrollment.

Open Enrollment Begins November 1st
In Illinois, open enrollment begins November 1st. However, this does not mean you need to wait until November to sign up. Coverage can be effective Nov 1 as long as you begin the process before the date. Carriers like Blue Cross Blue Shield will allow you to begin submitting paperwork after the second week of October.

Autism Coverage is Mandatory in Illinois (almost always)
By 2015, 41 states had implemented an autism mandate under the Affordable Care Act. Illinois is one of those states. This means Illinois requires insurance carriers to cover autism services - including Applied Behavior Analysis (ABA). For the families we work with at Autism Family Center, this has been by far the biggest benefit of the Affordable Care Act. Families now have coverage for intensive, and medically necessary, therapeutic programs.

The Loophole - when autism services are not covered
There is a loophole to the Illinois Autism Mandate. Some plans are “Self-Funded.” This means that the employer actually funds the plan. When plans are self-funded, then employers have the option to opt out-out of the mandate. Self-Funded plans are only an option if the healthcare plan comes from the employer. All other plans, especially those purchased through the Health Marketplace will cover autism services.

You can access “Obamacare” on the Health Marketplace
Obamacare is sometimes confused as an actual insurance carrier or policy. However, it is a series of laws and regulations that insurance plans must abide by. The plans can come from any carrier - such as Blue Cross Blue Shield and Aetna. To enroll in any of these plans, individuals can use a website called the Health Marketplace. On the Health Marketplace, anyone can browse plans to choose the best option for them. Any plan purchased on the Marketplace will cover autism services.

So there you have it. This barely grazes the surface when it comes to the complexity of coverage under the Affordable Care Act (ACA). However, if your family is affected by autism, this is the time of year to assess how comprehensive your insurance plan is. Intensive services, like Applied Behavior Analysis (ABA), can be enormously impactful. All children deserve access to this care. Whether or not you are a fan of Obamacare, there are now more options for families affected by autism.

Contact Lauren Rabin to learn more about services and coverage in Illinois:laurenrabin@autismfamilycenter.com. You can also visit our website:www.autismfamilycenter.com