ABA Coverage in Individual and Marketplace Plans in Michigan
Employees sometimes buy individual coverage, or receive an ICHRA allowance to do so. Here is how ABA fits.
What applies to individual coverage
Individual plans
DIFS says all individual health plans purchased on and off the Health Insurance Marketplace must provide autism benefits.
Exchange limit in the statute
A qualified health plan offered through the state exchange is not required to cover under the section to the extent it exceeds the essential health benefits.
ABA is habilitative
DIFS categorizes ABA as a habilitative service in Michigan’s essential health benefits, which is how ABA enters the individual market.
Employer allowances
An employer that funds individual coverage through a reimbursement arrangement is not the insurer, so the carrier’s policy governs ABA coverage.
Back to the ABA guide.
ABA Coverage in Individual and Marketplace Plans in Michigan: short answers
Does an individual plan cover ABA in Michigan?
DIFS says it must. Confirm the specific plan’s autism provision before enrolling.
What if we use an ICHRA?
The employee’s individual plan covers ABA under the mandate and the essential health benefits, not the employer.
Where can employees compare plans?
On the Health Insurance Marketplace or with a licensed broker. Ask each plan about ABA providers and authorization.
ABA Coverage in Individual and Marketplace Plans 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.
DIFS: Autism Spectrum Disorder Health Coverage
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