For instance, insurers could choose to cover physical therapy for someone with a broken bone, but not cover long-term support services for chronic conditions, such as speech therapy for kids with developmental delays.
Clemans-Cope says some insurers may arrange their benefits in a way that discourages people with expensive chronic conditions from signing up with them. And, she says, people who want to have specific therapies covered are going have to slog through some fine print to figure out if they'll actually benefit from a particular policy. (The new policies will start to go on sale this fall and go into effect beginning Jan. 1, 2014.)
"This is a big improvement, but we should emphasize that it's not totally fixed," Clemans-Cope says. "And people are really going to have to get help to decide which plans cover the benefits they need. "
Whether a person will be able to get the new therapy benefits also depends on where they live. The level of benefits insurers have to provide in each category is based on a model policy in each state, and some of those model policies are a lot more generous than others.
Jill Tappert, an activist in Colorado for people with disabilities, says a lot of details still need to be sorted out before she'll be able to say whether the health care law has improved things much.
"I certainly hope the way the Affordable Care Act is implemented is a game changer for people in the disabilities community. It can be," says Tappert, who spent years fighting for habilitative service coverage for her daughter who has autism. "The opportunity is there for policy makers to vastly improve lives."
Barbara Vernon, Bryce's mother, says Bryce is now covered by Medi-Cal, California's Medicaid program. His primary insurance had been her employer-sponsored plan until she was laid off in 2009. She searched for private coverage for Bryce, but says, "Private was so unbelievably expensive, it was unaffordable."
Barbara says her family's insurance is "a patchwork," with Bryce likely to stay on Medi-Cal even after his 21st birthday. She and her other son have an individual plan they have purchased, and her husband has an employer-sponsored plan -- but it covers only the employee, not the family.
Fri, Aug 09 2013