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Health insurance offerings have drastically changed over the years. In order to contain costs, meet regulatory guidelines and make policies affordable health insurance providers now offer a number of options as add-ons that use to be standard fare.
Did you know that dental, prescription, and vision coverage is now an optional add-on to most policies? While some plans still include this coverage as part of the standard policy, many provide it as an option – available at additional cost. Others require subscribers to buy a separate insurance policy altogether for dental, prescription, and vision coverage.
Reviewing the family’s past use of these services and anticipating possible expenses down the road will determine whether optional add-ons are necessary.
Coverage considerations for those with Cerebral Palsy include:
- Dental coverage
- Prescription coverage
- Vision coverage
- Complementary and alternative medicine coverage
Dental considerations are important for families who have a child with Cerebral Palsy, especially if the child has an oral-motor dysfunction. Lack of facial muscle control may contribute to drooling, acid reflux, or aspiration. These conditions lead to dental challenges.
Dental insurance helps pay for the costs associated with dental care. Children with special health care needs are more at risk to develop dental infection and disease. Dental insurance is a gateway providing access to preventive dental programs and coverage of other dental costs. Access to an individualized dental program for a child with Cerebral Palsy may prevent possible delay in dental care and provide parents and caregivers with specific oral hygiene procedures and instructions. Types of dental plans (HMO, PPO, Fee-for-Service, and Discount Plans) may be obtained individually or through employer-sponsored programs. Other government-sponsored dental coverage may be offered through Medicaid and CHIP programs.
Medicaid requires individuals under the age of 21 to receive dental services. Each state seeks advice from dental organizations determining customary care. Services may include preventive care, dental health maintenance, oral screening, and treatment of conditions discovered at screenings. Dental services are not required, but optional for individuals 21 and older under the Medicaid program.
The Children’s Health Insurance Program, CHIP, is another source that provides dental services for eligible children up to age 19. Dental options and out-of-pocket expenses for this program vary state by state. Some states may combine the CHIP and Medicaid programs.
Prescriptions are written to control pain, muscles, movement, and spasticity. Prescriptions can be costly. Having prescription coverage may be a priority to some.
Prescription insurance is a plan that helps pay for prescription medications and drug therapy. Health insurance plans may cover prescription drugs, but many may have a “formulary,” a list of specific medications that are covered. Some plans may only pay for the generic form of a medication. Co-pays may differ. Other plans may not cover specific medications at all. Plan guidelines vary.
A comprehensive insurance plan covers the necessary medications to aid with Cerebral Palsy, associative conditions, and other co-mitigating factors recommended by the Cerebral Palsy care team. These may include drug therapies to alleviate, or help, with muscle tension, mobility impairments, involuntary movements, spasticity, writhing, pain, hyperactivity, constipation and seizures. When considering a plan it is important to confirm if necessary medications are covered. Insurance plans with little to no prescription insurance may result in high costs and major out-of-pocket expenses. Prescription assistance may be available with plans, such as patient prescription assistance programs, Medicare Prescription Drug Coverage (Part D), and other government-sponsored options. Local Medicare and Health and Human Service offices may also offer help with information and prescription assistance resources.
Vision and hearing impairment is common in individuals with Cerebral Palsy. Vision insurance coverage can cover typical eye exams, contacts, and eyeglasses. Some policies encourage prevention and standard care, while others focus on the risk of having major medical services, like eye surgery or vision correction.
Although vision coverage is important, some may find the optometrist office offers plans that equal or surpass the coverage allowed under a health insurance plan. Some optometrist plan may only cover optical equipment, and not major medical expenses.
Complementary and alternative medicine coverage
Complementary and alternative medicine, CAM, incorporates treatments and therapies not considered part of traditional medicine. They may include, for example, massage therapy, chiropractic services, herbal supplements or acupuncture.
Treatments that replace traditional medicine are usually referred to as alternative medicine. Treatments that coincide with traditional medicine is usually termed complementary. Whether complementary or alternative, all treatments should be reported to the child’s primary care physician. Physicians review treatment protocol for conflicts. They are concerned with treatments which may positively or negatively impact an aspect of the child’s care. Research is increasingly being conducted on CAMs so practitioners become aware of the possible side effects and interactions with other treatment. However, some CAM modalities have not yet been approved or researched thoroughly. For this reason, insurance plans often do not cover CAM treatments.
If CAMs are not part of the current insurance plan, the direct expense should be included in a yearly medical planning budget. It is not uncommon for individuals without insurance to ask a provider for a quote or payment arrangement prior to obtaining service.
Finding affordable health insurance for children and adults with long-term medical conditions, such as Cerebral Palsy, can be a major concern for most parents. A health insurance policy is a contract between an insurance company and a policy holder intended to safeguard against high and unexpected health care costs.