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How to get the most out of health insurance for your child with disabilities

Learn how to get the most out of your health insurance to cover the needs of a child with a disability.

A boy smiles as the doctor checks his hearing aid.

Health insurance plans cover things like doctor’s visits, medicines, and hospital stays. But they also offer special services for people with disabilities. If your child has a disability, you want to make sure they’re getting all the helpful services they can.

If you know how to get the most out of your health insurance, you can better meet your child’s–and your family’s–needs.

Here are your key take-aways:

  • Make sure your child has a good insurance plan
  • Make sure your insurance company knows about your child’s disability
  • Find out what your plan covers
  • Get Prior Authorizations if you need them
  • Learn how to manage your child’s insurance when they turn 18

Learn about why health insurance is important, and how to get it if you don’t have it.

Make sure your child has a good insurance plan

Not all health plans are the same, and some offer better benefits for children with disabilities. If you have a choice of health plans through your employer or the government’s Healthcare Exchange or Marketplace, look into the disability benefits and compare the options. If you find a better plan than the one you have, it may be worth switching. (You may have to wait until the plan’s open enrollment period.)

Even if you have private insurance, your child may be able to get secondary insurance, like Medicaid or CHIP (the Children’s Health Insurance Program).

Medicaid has excellent disability benefits, and the income guidelines are different for people with disabilities. Even if your family doesn’t qualify for Medicaid because of the income limits, your child may qualify.

Learn more about Medicaid and how to apply.

Make sure your insurance company knows about your child’s disability

You may have to document your child’s disability for the insurance company. They may need medical reports or evaluation results to prove that your child qualifies for any disability-related services.

Here’s what you can do:

  • Call the number on your child’s insurance card
  • Tell the insurance company about your child’s diagnosis. Describe your child’s needs in detail
  • Ask if they need anything in writing to confirm the diagnosis, like a school evaluation or letter from a doctor
  • Send in or upload the required documents

Find out what your plan covers

To get the most out of health insurance for your child with a disability, find out what services or benefits your plan offers that relate to disabilities.

Disability-related services may include:

How to find your health plan’s disability services:

  1. Call the customer service number on the back of your insurance card
  2. Explore your health plan’s website
  3. Look up the benefits in your Member’s Handbook 

It can be hard to get the right information! But if you’re persistent, you might find other benefits from your insurance plan that you didn’t know about. 

If you’re unsure what’s available, call and talk to a real person at the health plan. If you get your health insurance through your employer, the Human Resources Department may also be able to help.

Prior Authorization: Get services approved ahead of time

Most health insurance benefits are covered without having to do anything, but some of them need to be approved in advance. This is called prior authorization. This is only for certain kinds of benefits, services, or medicines. 

This may apply to therapies like speech or occupational therapy, or sometimes medical equipment and devices.

If you’re not sure if a benefit needs prior authorization, call the number on the back of your child’s card. Ask if prior authorization is required, and what you need to do. If your child has an urgent need for something, ask as soon as possible so you have time to ask your provider to do the paperwork!

If your child is over 18

Once your child turns 18, they are considered an adult and you no longer have the right to speak for them. Here are a couple things to know about their health insurance:

  • If you want to manage the health plan benefits for a child who is over 18, you need to get permission 
  • Your child can be covered under your plan until they are 26 years old. In some cases, if they have a disability, they may be able to stay on your plan for longer

Learn more about what to do when your child turns 18.

Get permission to talk with your child’s insurance plan

Health insurance plans have to follow HIPAA, which is a set of rules about privacy for health care information. As parents, you can talk to the insurance company about your child’s benefits, but when your child turns 18, you have to get your child’s permission.

This is important if you need to:

  • File a claim
  • See if the plan covers certain services or drugs
  • Appeal if they deny coverage for something

Here’s what you can do:

  1. all the insurance company. Use the number on the back of your child’s insurance card. Ask if you’re allowed to speak to them about the plan
  2. If they say that you’re not authorized, follow their instructions
  3. You may need to submit documents to the insurance company showing that you have the legal right to speak on behalf of your child. These could be things like a custody agreement, guardianship, general power of attorney, or a health proxy

If someone else (like your spouse or ex-spouse) owns the policy, tell the policy owner to call and ask the insurance company to give you permission. The policy owner may need to fill out a form.

If your child has Medicaid and turns 18, call the number on your card and ask to be an Authorized Representative. You will have to fill out a form and submit it.

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Need help managing your child’s health insurance in Massachusetts?

Call Healthcare for All for help with health insurance.

If your child is autistic:

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Keeping your adult child on your health plan after age 18

Thanks to the Affordable Care Act (ACA), all children can stay on their parent’s health insurance plan until they turn 26 years old. Call your plan before your child turns 18 to confirm that they will stay on it.

Some plans will let your child stay on your plan after age 26 if the child has disabilities. The rules vary for different health plans. Call your plan and ask if your child’s situation allows this extension.

We hope this helped you understand how to get the most out of health insurance for your child with disabilities. Health insurance can be complicated, but it’s worth doing some research into your plan to see what services it may cover that will help your child. Remember you can always call the number on your insurance card to get your questions answered.

Learn More:

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