ABA Coverage After Age 18 in Michigan
Families ask what happens when a child with autism turns 19. The answer depends on the plan, not on a single rule.
What decides coverage after 18
The statute’s wording
An insurer may limit coverage to members through 18 years of age. The statute does not require an age cutoff and does not require coverage to end there.
The state’s two messages
The state autism program says coverage may be limited through age 18, while the insurance regulator lists age limits as prohibited. The policy language is what controls.
Self-funded plans
A self-funded plan decides for itself. The plan document may cover ABA for adults, cover it with limits, or not cover it.
Other routes
Behavioral health and therapy benefits in the same plan may still apply to older members even where a plan treats ABA differently. Ask which benefit applies.
Back to the ABA guide.
ABA Coverage After Age 18 in Michigan: short answers
Does ABA coverage automatically end at 19?
Not under the statute. It permits an age limit but does not require one. Read the certificate.
What should we ask the carrier?
Whether the plan applies any age cutoff to autism treatment, what happens to a member who turns 19 mid-year, and which benefit covers older members in writing.
Where are adult autism services covered?
That depends on the plan. Some behavioral health benefits apply regardless of age, and some public programs serve adults. Ask the carrier and the state autism program.
ABA Coverage After Age 18 in Michigan: not legal advice. Send us your renewal.
Where these details come from
The laws and rules named on this page link to the official text. This is general information, not legal advice, and rules change, so check the current text.
MCL 500.3406s, Insurance Code of 1956
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