Legal & Planning

The Affordable Care Act: what it means for individuals with disabilities

By now, you have probably heard about the Supreme Court’s highly anticipated ruling on President Obama’s health care reform legislation, the Affordable Care Act.

Much discussion has focused on what this ruling means for the general public; however, little attention has been devoted to what it means for people with disabilities.  Below is a summary of the Act and how it affects individuals with special needs.

No Pre-Existing Condition Exclusions

Currently in effect: Currently in effect, insurance policies cannot deny or exclude coverage to any child under age 19 based on a pre-existing condition.  This means that children on a parent’s policy must be granted coverage. If you have health coverage through your employer, the plan is allowed to exclude coverage temporarily for pre-existing conditions, including disabilities, usually for no more than one year and waiting periods for coverage of pre-existing conditions starting in 2014 will be limited to 90 days. In 2014: Starting in 2014, insurance policies can no longer deny or exclude coverage to anyone based on a pre-existing condition.  Furthermore, insurers will not be allowed to charge higher premiums for these individuals to get coverage. This is perhaps the most significant change impacting individuals with disabilities who have previously been denied private health insurance coverage.  Now, starting in 2014, if you can afford private health insurance, you can get private health insurance. To bridge the period between now and 2014 when the law takes effect, the federal government has set up the Pre-Existing Insurance Plan to provide coverage for eligible citizens who have been uninsured for 6 months due to a pre-existing condition.  For more information on this program, visit www.pcip.gov.

No Lifetime or Annual Limits on Coverage

Under the ACA, starting in 2014, insurance policies can no longer impose lifetime or annual dollar limits on coverage.  Previously, once you hit your maximum benefit amount, you would have to pay for all medical services out of your own pocket or have supplemental insurance coverage.  Elimination of this cap on lifetime and annual benefits is significant for those with frequent and expensive medical costs.  This provision applies to all policies in the new insurance exchanges and non-grandfathered policies.  To see how your policy will be affected, contact your insurance carrier or agent.

Extension of Dependent Coverage

Currently in effect and unaffected by the Supreme Court’s decision, children can stay on their parent’s insurance policy through the age of 26.  For individuals with disabilities, this coverage may be extended throughout adulthood depending on state law and policy rules for dependent coverage.

Access to Preventative Care Services

The ACA requires health plans to offer coverage for certain preventative services without charging the consumer a co-pay, coinsurance, or a deductible.  This means that some preventative services, like an annual physical exam, are now available at no cost, so long as you have health insurance.  This is important as people with disabilities may have avoided these types of services in order to conserve resources for health care costs needed for other services.  See  a full list of covered preventative services here.

Coverage for Essential Services

Starting in 2014, new individual policies and plans purchased through the insurance exchanges will have to cover essential benefits like hospitalizations, doctor visits, prescription drugs, rehabilitation and mental health services, pregnancy and newborn care.

Policies Cannot Be Cancelled

Policies cannot be cancelled if it is found that the consumer made a minor error on the application.  Furthermore, insurance companies cannot rescind the policy or decline to renew the policy if an individual becomes sick.

Expansion of Programs

There are many provisions in the ACA that include funding for the expansion of programs for people with disabilities.  For example, the ACA includes new grants for Medicaid waiver programs to support state initiatives to provide greater community-based services. Regardless of your political beliefs, the ACA for the first time makes private insurance a viable option for individuals with disabilities.  Scholars speculate that the availability of private insurance may lead to less reliance on federal benefits like SSI, which are often a pre-cursor to access Medicaid.  Whether you choose to go with private insurance or Medicaid should be based on an informed decision looking at your health care needs and financial resources and goals.  Information in this article is not intended and cannot replace consultation with an attorney specializing in special needs issues.