If you have a disability -- or your child does -- you'll get new benefits under the Affordable Care Act. You can't be turned down for insurance because of a disability. You may pay less for care. You'll also have an easier time getting the treatment you need.
Both physical and mental disabilities qualify. Some examples include:
- You had a stroke and it has affected your speech, vision, or movement.
- Your child is a young adult with a learning disability that has kept him or her from getting a job and living independently.
- You have a slipped disc that makes it impossible for you to work.
- You have bipolar disorder, which has kept you from getting or keeping a job.
Essential Health Benefits
By law, almost all health plans must cover a list of 10 "essential health benefits." This includes care that can help you manage your disability. These benefits include:
Rehabilitation services. This is a type of treatment that helps you regain function you lost because of your condition. You can also get habilitative help. It's treatment that helps you learn and develop skills important to your day-to-day life.
Mental health services. You can get counseling for mental illnesses like bipolar disorder or schizophrenia. You can also get medicine for your condition. And you can get a free screening for depression.
Insurance companies that sell health plans through your state's insurance Marketplace must include these essential health benefits -- with a few exceptions. Older health plans with “grandfathered” status don't have to cover the essential health benefits package. Neither do large employer plans, though most cover them anyway. Be sure to check the details of what your plan covers before seeking care.
The Affordable Care Act protects your insurance coverage in several ways:
- You cannot be dropped from your plan because you have a disability.
- Your plan must cover your child, even if the child has a disability.
- Starting in 2014, you cannot be turned down for coverage if you have a disability.
- Your children can stay on your plan until they reach age 26.
You will also benefit from rules in the law that keep you from paying too much for your care or medicine. For instance:
- You will not have a dollar limit on how much the plan can spend on your care. Annual and lifetime limits go away.
- You cannot be charged more for insurance because you are sick or disabled.
- Your out-of-pocket costs are capped. There's a limit on how much you will spend each year. After reaching that amount, your plan covers all costs. That includes copays and deductibles.
If you're struggling to live on your own with a disability, health care reform offers programs that can help you stay independent. Many states will offer more community-based support services that you can get in your home. They may help you with day-to-day living and improve your quality of life.