Health Insurance For Children With Cerebral Palsy

Parents of children with cerebral palsy incur extensive medical bills, typically as a result of medical screening and ongoing physical and occupational therapy. According to a 2009 Pediatrics study, 91.2 percent of parents with disabled children incur out-of-pocket health care expenses. Depending on the severity of the condition, these costs may range from hundreds to tens of thousands of dollars. The right health insurance program can ease some of this financial burden, however, so it is imperative that parents choose wisely.

Selecting a Provider

When choosing a provider, parents of CP-diagnosed children must consider the frequency with which they will visit their primary care provider, their physical therapist, and other medical specialists. Common employer-based options include health savings accounts (HSA), health maintenance organizations (HMO), and preferred provider organizations (PPO). Because the numerous treatments CP patients incur often go well beyond what is available in an HSA, PPO and HMO plans are typically preferable for families affected by CP.

If cost is not a primary concern, parents of children with CP may prefer a fee-for-service approach to health care (sometimes referred to as indemnity), which allows for greater flexibility in pursuing treatments and health care providers. This is an ideal approach if parents desire greater control over their children’s health care outcomes, as parents are free to choose the best physicians and specialists, regardless of network.

Finding Individual Coverage

Those who lack employer-based health insurance or other forms of group coverage may be forced to enter the market on their own. Currently, the Affordable Care Act promotes state-based marketplaces, which allow residents to choose from a variety of plans within a given enrollment period. Individuals and families cannot be barred from plans included on the individual marketplace due to pre-existing conditions.

Medicaid

Not all parents of children with CP qualify for Medicaid, but it is a viable options for low-income families struggling under the added burden of CP-related medical expenses. Medicaid offers extensive coverage for a wide range of services typically pursued by CP patients, including the following:

• Physician visits
• Physical therapy
• Pain medication
• Hospitalization
• Home health care
• Mental health services

Coverage varies somewhat from one state to the next, but generally, if a needed service is not covered in a given state, the patient can apply for a special waiver. Complications sometimes arise when medical services are offered in school; under the Individuals with Disabilities Education Act (IDEA), non-educational agencies that provide services (such as speech language pathology treatments) in an educational setting are financially responsible.

The importance of quality health insurance coverage cannot be overstated for children with CP. Those with proper coverage are more likely to obtain early interventions, which can greatly enhance long-term quality of life. If you do not believe you can afford insurance, apply for Medicaid or for special credits through the individual marketplace.