A Review of Current Insurance Topics

Contributed by Chaunta Tsegaye, MSA, WIP-C, Program Manager/Insurance Specialist

Every year I try to find something more insightful than the year before to share with families and this year I have landed on the fact that we should talk more about Social Security Benefits and how they interact with insurance. We should also mention that some private insurers have removed the age limit restriction on Applied Behavior Analysis (ABA) services and the effect this will have on families. Let’s get started.

Social Security 

Some of the families in our community find themselves financially ineligible for Social Security when their children are younger because they exceed the maximum household income limits. As these children become adults it becomes more important to look at Social Security as an option for prolonged insurance coverage and financial contributions.  Although Social Security is not profitable enough to live the lifestyle that some people have become accustomed to as children, it can give them a sense of security if they find themselves without substantial gainful employment for a prolonged period of time. If eligible for insurance it will provide coverage for preventative care,  hospitalizations, and ancillary services.  Although this seems minimal at first glance we all know that medical expenses can accumulate rather quickly.  Something to remember, most plans will not cover dental and vision so you should consider alternative insurance plans if you are seeking those specific benefits.

Once a candidate has filed for and received Social Security benefits they will be eligible for Medicare in 24 months.  In some instances the candidates are also eligible for Medicaid.  If they are eligible for both, Medicare becomes their primary, and Medicaid becomes their secondary insurance.  This transition from parents coverage to individual federal/state funded insurance requires that you do the following:

  • Check with your provider to see if they accept Medicare insurance.

  • Make sure that you follow the enrollment guidelines for the new insurance.

  • Report all changes to the Social Security Administration (SSA) immediately.

 If you have questions regarding Medicare you can reach out to the Medicare/Medicaid Assistance Program (MMAP) for help 1-800-803-7174. If you need Medicaid assistance you will still need to apply and be approved for the program.  Be sure when applying for services for an adult child that they are using their own income as the qualifying income source and not that of the family.

Applied Behavior Analysis

In 2022 Blue Cross Blue Shield of Michigan lifted the age limits for ABA services.  This comes as a great relief to families who would like to continue services for their children after age 18 for some private insurers, and age 21 for those with dual coverage Medicaid.  As families prepare for this change there are some things that they should remember:

  • The requirements for authorization are still the same: the child/young adult has to have a diagnosis from the professional designated by the insurance company.

  • There is a cost savings when you visit an in-network provider, but deductible, co-pays, and co-insurances still apply.  Having unlimited visits will not eliminate the cost associated with therapy.

  • All insurers require a parent component for continued authorization.

If you do not have Blue Cross Blue Shield you should check with your insurer to see if they have made these changes to age limits.

As always, if you are unsure and have any questions please contact MiNavigator at 877.463.2266, or reach us at our newly refreshed website: https://autismallianceofmichigan.org