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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Reform Affects Disability Care

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 autism 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, all health plans sold in state Marketplaces, on the individual market, or through small employers 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 services, 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.
  • Chronic disease management. You can get help managing chronic health conditions such as arthritis and heart disease.

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.

Integrating Care

The Affordable Care Act focuses on your individual care through “medical homes” and “accountable care organizations.” These are health-care models that focus on coordinating care from doctors, other providers, and organizations in a variety of settings. That is especially important for people with disabilities who may see several doctors.

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