Getting Health Insurance For A Child With Juvenile Arthritis

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As a parent, you want the best health care for your child – especially when that child has a chronic condition like juvenile arthritis (JA). The Affordable Care Act (ACA) brings important changes to health insurance coverage that could affect the care your child receives.

Your Child Can’t Be Denied Coverage
Insurance companies can’t turn you down, raise your rates, or cancel your policy because of your child’s condition.

You Can Keep Your Child on Your Policy Longer
In the past, your health insurer could drop coverage for your child once he or she turned 19 or graduated from college. Under the ACA, insurers must keep your children on your policy until age 26 – even if they’re married, or are eligible to enroll in an employer’s plan.

You’ll Be Able to Shop Around for Health Insurance
If you don’t have coverage under an employer plan, Medicare or Medicaid, you can shop for insurance plans in the new Health Insurance Marketplace. There are four tiers – bronze, silver, gold, platinum. The gold and platinum plans charge a higher premium but have lower out-of-pocket costs – which may be better if your child often needs to see a doctor. When comparing plans, make sure your child’s doctors are in network. Also, “It’s important to look at the arthritis drugs that are covered in the plan and how much of the cost is covered,” explains Joe Touschner, senior health policy analyst with the Center for Children and Families at the Georgetown University Health Policy Institute.

Your Child Can Get More Benefits
The ACA includes a number of essential benefits – including vaccinations, annual routine eye exams, coverage for brand name and generic prescription drugs, and physical therapy. “The essential benefits provide a more comprehensive package than was available in the individual market before ACA,” Touschner says. Which services – and how many – are covered will depend on where you live. For example, if you live in Georgia you’ll be eligible for 20 physical therapy or other rehabilitation visits per year. For similar services, people living in Arizona will get 60 visits, while those in California have no limit on the number of visits.

You’ll Get Access to Cheaper Biologic Drugs
The ACA has paved the way for biosimilar versions of biologics to reach the market more quickly. Biosimilars slow the progression of joint damage just like biologics, but they’re cheaper.

You May Qualify for Medicaid
If you’re having trouble paying for your family’s health insurance, under ACA you may now qualify for Medicaid. Some states are expanding their Medicaid coverage (as of this writing, 25 states were participating). If your state is one of them, you can qualify if you make up to $32,500 a year for a family of four [this could change in 2014]. If you don’t quite qualify for Medicaid but you can’t afford private insurance, your child could be eligible for the Children’s Health Insurance Program (CHIP), which covers uninsured children up to age 19.

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