Medical insurance is important for everyone. It pays for emergency care if you get sick or injured, which is a huge benefit. (It can cost thousands of dollars to stay in the hospital, even for a small procedure.) But it does a lot more than that. Medical insurance pays for regular checkups and health screenings even if you’re not sick. This can prevent health problems later on because you can catch a potential problem earlier. Health insurance also covers programs to help you to get healthy and stay healthy.
Medical Insurance Basics
Medical insurance is also called health insurance or a health plan. It pays for both regular and emergency care, so you can stay healthy and get care quickly if you get sick. Usually you pay a monthly cost (a premium) and then a small portion (co-pay) for certain types of doctor’s appointments.
But health insurance is complicated and confusing. There are many choices, and they all have different costs and different benefits. Benefits are the services your health plan pays for (covers), like yearly check-ups, and tests and treatments for different conditions.
Why is it important to have medical insurance for a child with a disability?
It’s especially important to have medical insurance for a child with a disability. Children grow and change quickly, so it’s important to keep up with their regular check-ups, or well-child visits. For kids with developmental disabilities, these well-child visits are a good way to keep track of different developmental milestones. If your child is not hitting their milestones, they may need a screening or more thorough evaluation to see if there’s a new diagnosis. This, in turn, will help you learn what kind of support, services, or therapies your child may need to help with their development.
Many health plans cover special services for people with disabilities. These may include special testing and evaluation, different kinds of therapies, or support for living and working in the community. Some plans also cover equipment for medical, mobility, or communication needs. For example, if your child needs a wheelchair, a hearing aid, a leg brace, or a communication device, these may all be covered by your insurance.
These benefits add up to a ton of critical supports that would otherwise be so expensive, many families would maybe have to skip some services their child needs.
What is the Affordable Care Act?
The Affordable Care Act (ACA), also known as Obamacare, is a law passed in 2010 that makes it easier and cheaper to get health insurance. It also requires insurance companies to pay for a minimum set of services like check-ups, emergency care, mental health care, and maternity services. The ACA also prevents health insurance companies from denying insurance–or charging more–if you already have a health condition (a pre-existing condition).
How to get medical insurance
There are 2 main kinds of insurance you can get:
- Medicaid — Government-run insurance for people with low income or disabilities
- Private health insurance — You can get this through your employer or on your own
Medicaid is a good health insurance for a child with disabilities. It has good disability benefits that other health plans may not have. Even if you have private insurance, you may be able to get Medicaid as secondary insurance. Qualifying for Medicaid depends on the child’s disability and the family’s income. Your child may qualify based on their disability, even if your family’s income is over the limit. Each state also has a Children’s Health Insurance Program (CHIP), which is partly connected to Medicaid.
To get private insurance, you can go through your employer or the Health Insurance Marketplace.
Insurance from your employer
Under the Affordable Care Act (Obamacare), most employers are required to offer a health insurance plan to their employees.
They might have a few plans for you to choose from.
Here’s what you can do:
- Contact your employer’s Human Resource (HR) department
- Ask about your health plan options, and when the enrollment periods are (Sometimes you can only sign up or change your health plan at certain times of the year)
- Tell them about your family member who has a disability, and ask if they can help you pick one that may be best
- Make sure to find out about the benefits and monthly costs (premiums) for each choice
The Health Insurance Marketplace
To get health insurance without going through your employer, you can use the federal government’s Healthcare Exchange or Marketplace. This was set up through the ACA to help people compare different health plans and sign up for health insurance. To apply for coverage through Healthcare Marketplace, go to Healthcare.gov
- Each state has a set of options for different insurance plans you can get. Learn about the costs and benefits before you decide which to enroll in
- There are specific enrollment periods when you can get a new insurance plan, or change the one you have. But even if you have missed the deadline, there are still chances to enroll in specific programs
- As you apply for insurance through the Marketplace, they will tell you if you qualify for Medicaid
- See this brochure for more tips about the Marketplace
Choosing the right medical insurance for a child with a disability
Whether you’re looking for health insurance through your employer or the Marketplace, you’ll probably have a choice of different plans. How do you know which is right for your child or your family? Here are some questions to ask:
- What benefits–that my child uses–does the plan cover? Ask about things like speech therapy, medical equipment, developmental testing, and other services that your child may need
- Are my child’s doctors and specialists in the network? Each plan has a list of in-network providers that it covers. You may have to pay extra for out-of-network providers
- What are the out-of-pocket expenses? These include the co-pays for different kinds of visits, the deductible (amount you have to pay per year before the insurance starts to pay), and other costs.
How to get care if you don’t yet have health insurance
If your family doesn’t have health insurance, it’s important to know how to get care anyway. You shouldn’t skip regular check-ups or doctor visits–there are ways to get basic care without insurance!
Free or low-cost care
Health insurance offers a lot more choices and services than what you can get for free or at low-cost. It is definitely worth having. But if you don’t have insurance and need care, there are ways to get it.
Community Health Centers
You should be able to get free or low-cost care at a community health center funded by the federal government. They have doctors and specialists who can see you, even if you have no insurance and can’t pay. If you are undocumented (in the US without immigration papers), they will not report your immigration status to anyone.
Health centers offer primary care: regular day-to-day care like well-visits or check-ups. Here, you can find a doctor who can see you regularly, get to know you, and coordinate with specialists. If you’re sick and need to go to a hospital, they can coordinate that too. They often have education programs to help you learn to stay healthy–like nutrition or quit-smoking classes.
Local Health Departments
You can also call your local public health department. They can help you find a place to get free or low-cost care, or disability-related services for your child.
It’s so important to have medical insurance for a child with a disability! Insurance can cover many disability-related services and supports that can help your child live their best life. It can also prevent you from having to use up your savings for medical care if your child gets hurt or has to stay in the hospital. If you don’t have health insurance, explore your options through your employer, the Marketplace, or Medicaid.