2020 Individual Insurance Open Enrollment Period

December 04, 2019

Health care professionals with child

The open enrollment period for individual insurance plans runs from November 1st to December 15th. Coverage begins January 1, 2020.

Do you need a health plan that covers your child’s autism treatment? Are you considering changing the plan you currently have?

Upon learning their child is diagnosed with autism and receiving treatment recommendations from their physician, many families discover that medically necessary interventions such as Applied Behavior Analysis (ABA) are not currently covered by their employer health plan or public health plans such as NJ FamilyCare.

One option is for families to purchase an individual plan for their child through New Jersey’s health insurance marketplace. Individual insurance plans issued in New Jersey must follow state mandates, including Health Benefits Coverage for Autism and Other Developmental Disabilities, which ensures that individuals with autism can receive medically necessary treatment, including ABA.

Several insurance companies issue individual plans in New Jersey. While all plans must provide mandated coverage, the amount that families will pay out-of-pocket depends of the type of plan they choose, and whether they qualify for a premium tax credit. Tax credits are determined by income as well as access to employer-sponsored health coverage.

If you qualify for a premium tax credit, you can save money by purchasing a plan on the health insurance marketplace at www.healthcare.gov. Otherwise, you can purchase a plan directly from an insurance company or with the help of an agent.

Not sure if you qualify for a tax credit or what plan you should choose? The New Jersey Department of Banking and Insurance provides a guide for consumers shopping for 2020 individual insurance plans and a table showing monthly rates for available plans.

The guide will help you determine whether to shop for a plan on the marketplace, or directly with an insurance company, and decide what kind of plan to buy based on several considerations such as:

  • Do my doctors and other providers participate in the insurer’s network?
  • How much I will pay for:
    • Monthly premium
    • Deductible
    • Copayment
    • Coinsurance
    • Prescription drugs
    • Maximum out-of-pocket for the year?

In addition, the guide offers contact information for help choosing plans on and off the marketplace and a list of carriers offering plans in 2020. Note: not all carriers offer plans through www.healthcare.gov, but all plans are subject to NJ insurance mandates.

Note: Children with autism who are eligible for DD services through PerformCare may also be found eligible to receive ABA services by meeting clinical criteria for intensive in-home (IIH) services. Check back with us for updates on the planned expansion of NJ FamilyCare coverage for children with autism coming in 2020. Autism New Jersey is a participant of the stakeholder group organized by the state.

If you have questions about health coverage options and autism, contact Autism New Jersey at 800.4.AUTISM or information@autismnj.org and download or order a copy of our publication Health Coverage Options for Autism and Other Developmental Disabilities.

Originally posted 12/13/2018
Updated 8/8/2019