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Health Care Reform:

Health Insurance & Affordable Care Act

Autism Coverage Varies From State to State

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Minnesota will require applied behavioral analysis in its Marketplace plans, but not until 2016.

Q: In the states that are providing coverage of autism treatment, is this availability a significant step in terms of helping families get treatment?

A: It does expand the possibility of treatment, but the out-of-pocket costs may still be too high for some families. Depending on the individual insurance plan and its copays, starting in 2015 a family may still have to pay up to the out-of-pocket cap of $12,700 for treatment. The fact that some states are requiring autism coverage is "a positive, but treatment may still be out of reach for a lot of families," says Doreen Granpeesheh, PhD, executive director of the Center for Autism and Related Disorders, a worldwide treatment provider headquartered  in Los Angeles.

Q: If I don’t have insurance, how much can autism treatments cost?

A: An hour of autism therapy can cost about $40. Depending upon the severity of the disorder and the number of hours a patient needs for therapy, the cost can range from $10,000 to $70,000 a year.

Q: Besides potentially getting coverage for autism treatment, in what other ways does the new law help parents of children with autism?

A: The law requires all insurance plans to pay for preventive health services for children. Included in that benefit are two autism screenings: one at 18 months old and another at 24 months old. Further, insurers are required to pay for five behavioral assessments for children between infancy and 17 years of age. The insurer cannot ask for a copay or coinsurance fee for any of these services.

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