Child-Only Health Insurance Plans
January 06, 2023
Health Insurance and Autism series.
If your employer’s self-funded plan doesn’t cover ABA and you don’t qualify for Medicaid coverage.
Families who have no coverage for ABA therapy under their employer-sponsored insurance plan can still purchase a child-only plan to ensure their child gets the therapy they need. All child-only health plans purchased through the state’s website are fully insured health plans and, therefore, must cover medically necessary ABA for children under 21.
Open Enrollment and Special Enrollment Periods
The general rule is that you can only buy new health insurance during the once-per-year open enrollment period (November 1 to January 31). However, some life-changing events can qualify you for a Special Enrollment Period (SEP), which would allow you to purchase a policy outside that window of time. Those life-changing events include:
- Losing health coverage
- Pregnancy, adoption, or a child being placed with a resource family
- Marriage, divorce, or legal separation
- Moving to New Jersey or to a new coverage area within New Jersey
- Becoming a U.S. citizen
- Significant changes in income
- Exceptional circumstances (error, natural disaster, medical issue preventing enrollment)
For more information, visit the SEP Overview created by the New Jersey Health Insurance Marketplace.
Use this link to get started and find out how much insurance may cost:
You will be prompted to enter the coverage year, your zip code, the members of your household and whether they need coverage, and your annual taxable household income.
You can also contact insurance companies directly to purchase a plan. Here is a list of insurance companies doing business in New Jersey who offer individual health coverage programs. Shopping around and comparing premiums may help you get the most coverage at the lowest price.
Things to Keep In Mind
New Jersey offers some premium subsidies for individuals who have no health coverage. If your child already has health insurance through your employer, you may not be eligible for those subsidies and will have to pay the full cost of the new premium in addition to whatever your current plan costs.
Remember that all insurance policies have deductibles, copays, and out of pocket expenses. If you are buying a child only plan, it will be up to you to compare the amount you would spend on treatment under your current insurance with the cost of the new plan’s potential premiums. Only then will you be able to see if adding more coverage will actually reduce your costs.
If you can’t figure out what type of health insurance you have, or if you have other questions about insurance and how to use it to cover autism diagnostic evaluations or applied behavior analysis, visit our insurance hub>>
Connect with an Autism New Jersey Helpline Specialist. Call 800.4.AUTISM Helpline or email firstname.lastname@example.org.