Health Insurance and Autism – Autism New Jersey #kredit

#nj health insurance

The financial cost of autism care can be high, especially for those with intensive needs. Private insurance plans may offset the cost. Understanding if you are covered depends on the type of plan you have and what laws and regulations apply.

Types of Plans

Certain therapies for individuals with autism may be covered under their health plan. The types of therapies that are covered and the amount of out of pocket expenses will vary depending on the type of plan covering the individual.

  • Fully insured plan – Offered by an employer or purchased by individuals in the Health Insurance Marketplace
  • Self-funded plan – Offered by employers (typically large employers)
  • Public health plan – Offered through Medicaid and the Children s Health Insurance Program (CHIP), and is available to individuals with and without disabilities who meet certain income guidelines

Laws that May Impact Coverage

Other factors that impact coverage are federal and state laws. Not all laws apply to all types of plans. The most important laws affecting health coverage for people with autism are:

  • Amendments to NJ Insurance Mandate (2014) — Expands coverage to adults, removes visit limitations for OT/PT/Speech

Implementation Concerns

Just because there are laws in place, there still may be obstacles to accessing coverage.

  • In-Network Exceptions – What to do when you can’t find and In-Network Provider?
  • Claims and Authorization – Who do I call at my insurance company?

Autism New Jersey Public Policy

Learn more about our steadfast advocacy work in Trenton and our partnership with the legislature, state officials, industry officials, families and providers. We remain committed to improving access to quality, evidenced-based treatment for individuals with autism and to help lessen the financial burden on families.

Additional Resources

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