Child only plan on healthcare.gov? — The Bump
Special Needs

Child only plan on healthcare.gov?

We used DH's plan for our family this year and it covered ABA therapy.  We were very fortunate.  They have redesigned the plans for 2015 and it's no longer feasible.  We have to go on healthcare.gov.  Does anyone have one of these plans only for their child?  We're in TX so they have to cover ABA therapy.  This is too good to be true.  There is a plan with a monthly premium of $266 and out-of-pocket max of $1500, no deductible.  Everything accumulates to the out of pocket max.  I would get a separate plan with higher deductible, etc. for the rest of my family.  Can this work?  Is there some law against it?  Seems too good to be true.  Sure I'm missing something. 

 

Re: Child only plan on healthcare.gov?

  • greyt00greyt00
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    edited December 2014
    I'm guessing the catch is that I can only buy one plan per year?  Can DH buy the other one?

     
  • I think you are only eligible for subsidy if your employer does not offer coverage. But if you aren't asking for subsidy, I imagine anyone can buy in. I don't know if a parent has to have same plan as minor child.
  • I'm not asking for subsidy or credits or anything.  I'm looking at $1500 /month to put us all on 1 plan and get a low out of pocket limit for ABA.  It seems to be the cheapest (ha!) way to do it, besides splitting up people on different plans, maybe.  I flowed out costs on a few other plans with lower premiums but higher out-of-pocket costs and the high premium one was a little better.  I sort of feel like putting the rest of us on a lower premium plan is just asking for trouble, though.  Tempting fate.  Watch DS2 regress into autism January 1.  *sigh*  I have extreme paranoia when it comes to insurance decisions.  I know, I'll put us all on the high premium plan and then nothing bad will happen!  It'd be totally worth it.

     
  • Yeah, I'm very grateful that this provider is in network.  I hope it doesn't change. 

    I just don't understand how a policy with a premium of only $266 and out-of-pocket max of $1500 would pay for ABA.  That can't be true.  Unless of course there is some rule that my household can only purchase 1 plan through healthcare.gov.  I'm really afraid of making a mistake.  Like if they allow me to buy these policies but I later find out they're invalid.

     
  • I couldn't get into my old account on healthcare.gov (it is not accepting my security answers and they cannot reset it for me even though i gave them my SSN!!!) so I created a new one.  IN case anyone wants to know, you can put your entire family on the application and then put people into groups and buy a different plan for each group.  It seems to be a legit feature of the system. 

     
  • We have three different plans for four people. Dd is on Medicaid via a Katie Beckett waiver, ds and I on one plan and dh on another. It's fucking confusing but works awesome for us.
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  • I have several friends here in Texas who have bought child only plans in order to get ABA covered. (many of them were on plans that were self funded). It has worked out very well for them and was certainly cheaper then paying for ABA out of pocket!


    DS1: 4/15/2011
    Dx: ASD, SPD and receptive and expressive speech delay at 21 months
    BFP #2: CP 5/2012
    DS2: 4/24/2013
    BFP #4: Miscarriage at 5 weeks 7/2014
    BFP #5: 8/8/2014 Due 4/20/2015 
    Its a healthy girl!!!!! 
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  • Wow.  Thanks for the info.  How do you get a child-only plan that is self-funded?  Those are typically (always?) from employers and I never heard of a child-only plan from an employer.  Also, self-funded plans don't *usually* write in this type of coverage, and they certainly aren't required by law to have it.  That's interesting.  Of course I'm very happy for the people it's worked out for!

    I'm calling about my target plan right now and making sure there is no fine print for limitations on number of session/days treatment. And make sure that payments for ABA or autism-related services are not excluded from the accumulation feature.  I saw a plan on the exchange last year that said autism related coverage didn't count to the out-of-pocket max.


     
  • greyt00greyt00
    Seventh Anniversary 250 Love Its 500 Comments Photogenic
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    edited December 2014
    What?  Plans on healthcare.gov are individual plans.  Look at this link.  So these plans WON'T cover it?



    Never mind, ACA in TX makes it covered, like I thought.  So confusing.


     
  • Thank you.  After checking all our providers, I've seen that our pedi doesn't take a lot of these different plans, so now I may be putting both boys on the same plan and us parents on something else, where the pedi doesn't matter.  Well, that is if the application will let me group us this way.  I haven't done it yet. Our ABA provider is currently in network with Humana and even better, they have clients using that company in network.  So maybe it will work and I won't have so much grief this time.  Everything else I need is also in network with Humana.  As of today, anyway.  And it's not EPO so I'm not totally screwed if it changes. 

     
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