To begin with let me acknowledge that I am grateful for the Affordable Care Act. I am able to get ABA services for my son because of it. Employers can opt out of that coverage and most due (unless the founder/CEO/other bigwig is personally affected by it). Also, Roger will not be denied medical and behavioral services based on the pre existing condition of autism.
2015 was our first year using an ACA plan for Roger. We reached the out of pocket maximum in less than two months. He was able to attend the Easter Seals preschool. Without the insurance that would not have been possible since it costs $4900 a month ($58,800 a year). He is excelling and it has been a year of unimaginable growth. There have been some pitfalls with reviews of medical necessity, but, overall, an easy year.
Next year the medical doctor pool is dwindling for the ACA plans. Roger will still be able to have his ABA but speech, occupational therapy, and physical therapy options will be close to none as well as pediatrician and specialist options. It seems our only solution will be to place Roger both on his own ACA plan and on my employer plan. In addition to the increased costs of monthly premiums, we will still be reaching his ACA out of pocket maximum without it benefitting the cost of his other therapies and medical needs. Those will be on a plan with it’s separate deductible and out of pocket maximum.
We will take on the extra burden of cost, but what happens to those who cannot?