Open Enrollment for ACA Insurance Plans

Written by Dr. Laura Mraz, OTD, OTR/L
President, Illinois Occupational Therapy Association (ILOTA)

Navigating the healthcare system to find the right policy for an autistic child can feel overwhelming. This is where the Affordable Care Act (ACA) comes into play. It makes sure every family, no matter their income, diagnosis, or history, can find their way to the health care policy they need.

Before the Affordable Care Act, families were often denied coverage for pre‑existing conditions, charged sky‑high premiums, or could only access plans that excluded essential therapies.

ACA changed all of that. Now families raising children with Autism Spectrum Disorder (ASD) or other developmental differences can obtain the supports they need without the fear of being turned away.

Let’s take a closer look at the Affordable Care Act!

If you’d like more personalized insights, please reach out to Three Birds One Mission. We’re here to support you every step of the way!

What Is Open Enrollment?

Open Enrollment is the yearly window when families can sign up for health insurance through the Affordable Care Act (ACA) marketplace.

For many families, especially those raising children with autism or developmental differences, Open Enrollment is more than a bureaucratic deadline. It’s a planning season, a protection season, and a peace‑of‑mind season.

It’s the time when you can:

• Make sure your child’s therapists stay in‑network
• Confirm coverage for ABA, OT, PT, Speech, and mental health
• Adjust your plan if your child’s needs have changed
• Apply for subsidies that make coverage more affordable
• Prevent gaps in therapy or specialist access
• Switch plans if your current one no longer meets your needs

ACA Open Enrollment Periods Always Run from November to January

Since the federal marketplace standardized its schedule, ACA Open Enrollment has consistently run from November 1 through January 15 every year for all states that use HealthCare.gov (including Illinois).

The federal government keeps this window stable to make planning easier for families, clinics, and insurers.

For 2027 plans, Open Enrollment runs:

November 1, 2026 → January 15, 2027

Outside this window, you can only enroll or change plans after a qualifying life event, such as:

• Moving to a new state
• Losing other coverage
• Marriage or divorce
• Birth or adoption of a child

A gap in coverage can mean a gap in therapy.

When your child is building momentum in speech, occupational therapy, ABA, or physical therapy, consistency protects that progress. Reviewing your plan each year helps ensure the therapists and specialists your family relies on remain within reach.

Chicago-Specific ACA Resources

You don’t have to search endlessly. Here are the most important links for Illinois families, all in one place.

• Illinois ACA Marketplace: 🔗 HealthCare.gov
• Illinois Department of Insurance (IDOI): 🔗 IDOI Health Insurance Resources
• Get Covered Illinois: 🔗 getcoveredillinois.gov
• Chicago Enrollment Assistance: 🔗 Find Local ACA Help
• Illinois Medicaid & All Kids Program: 🔗 Illinois Medicaid / All Kids
• Autism Speaks Illinois: 🔗 autismspeaks.org
• National Disability Rights Network: 🔗 ndrn.org
• The Arc of Illinois: 🔗 thearcofil.org

Bookmark these now. When questions come up mid-application, you’ll be glad to have them ready.

What’s New for 2026–2027

The ACA transformed healthcare access for families with disabilities. Before 2010, insurers could deny coverage for pre-existing conditions.

Today, insurers cannot deny coverage due to disability, essential health benefits must be covered, and ASD therapies are included under rehabilitative and habilitative services.

Key updates for Chicago families include:

• Enhanced Subsidies Continue — More families qualify for lower premiums.
• The “Family Glitch” Fix Remains — Families can qualify for subsidies even if employer coverage is affordable for the employee only.
• Illinois Autism Mandates Stay Strong — Illinois requires coverage for ABA, speech therapy, OT, and other ASD supports.
• Mental Health Parity Enforcement Increased — Plans must demonstrate equal access to mental health services.

Therapies Covered for Children with ASD

ACA-compliant plans must cover rehabilitative and habilitative services. For your child, this typically means:

• Applied Behavior Analysis (ABA): An evidence-based approach that breaks complex skills into small, achievable steps using positive reinforcement. ABA helps build communication, social skills, and daily functioning.
• Speech Therapy: Supports expressive language (sharing thoughts), receptive language (understanding others), and social communication. For nonverbal children, Augmentative and Alternative Communication (AAC) tools — like picture boards or speech-generating devices — help give your child a voice.
• Occupational Therapy (OT): Builds daily living skills, sensory regulation, and fine motor skills. OT helps children who feel overwhelmed by sounds or textures learn to self-regulate, and supports skills like using utensils or tying shoes.
• Physical Therapy (PT): Supports strength, coordination, balance, and mobility — the physical foundation for confident movement.
• Mental Health Services: Counseling and family support to help children process emotions and strengthen the relationships that support their growth.

Illinois’s strong autism mandates give Chicago families an added layer of protection. Your child’s therapies are legally required to be covered.

How to Apply for ACA Insurance

1. Create an Account — 🔗 healthcare.gov

2. Complete Your Application — Provide household size and income to determine eligibility for premium tax credits, cost-sharing reductions, Medicaid, or CHIP.

3. Compare Plans — Look closely at therapy coverage, specialist networks, deductibles, copays, and out-of-pocket maximums.

4. Enroll — Submit your application and pay your first premium.

5. Get Help if Needed — Free enrollment assistance is available at 🔗 localhelp.healthcare.gov

Take it one step at a time. You don’t have to finish it all in one sitting.

Choosing the Right Plan

Start by listing everything your child currently uses — therapists, specialists, medications, clinics, and equipment needs. Then check whether each is in-network under any plan you’re considering.

Families with ASD often benefit most from Silver or Gold plans. These tiers offer lower out-of-pocket costs for frequent care, which is helpful when your child attends therapy several times a week, even if the monthly premium runs slightly higher.

Also, make sure to check your out-of-pocket maximum (the most you’ll pay in a year). Choose a limit that fits your budget, and confirm emergency and urgent care access as well.

Navigating Pre-Authorization, Networks, and Appeals

Even with strong coverage, roadblocks happen. Here’s how to handle them.

Pre-Authorization: Many plans require advance approval before therapy or medication begins. Ask your provider to submit thorough clinical documentation showing the care is medically necessary. Getting this right up front prevents delays.

In-Network vs. Out-of-Network: In-network providers cost far less. Always confirm network status before appointments. If no comparable in-network provider is available, ask about a network gap exception. Some plans offer partial reimbursement for out-of-network care. Check this before enrolling.

Appeals & Denials: If a claim is denied, ask for a written explanation. Work with your provider to gather evaluations, referrals, and session records, and file a formal appeal. Many denials are overturned when families advocate persistently. For free legal support, contact Equip for Equality at 🔗 equipforequality.org.

Open Enrollment is a powerful opportunity to secure the coverage your child needs. With thoughtful planning and the right resources, you can find a plan that truly fits your family. One that supports your child’s growth, independence, and wellbeing.

You know your child best, and you are their strongest advocate!

Virtual Information Session

Blue Bird Day partnered with John Novi of Cosmat Insurance to host a virtual Beyond the Nest on Open Enrollment. Watch the recording above for insights and additional information on Open Enrollment.

Learn more about the Affordable Care Act in my post on “The Power of the Affordable Care Act: A Lifeline for Families with Disabilities.”

Frequently Asked Questions

How do I choose the right ACA plan if my child has autism or developmental needs?
Start with a list of your child’s current therapists, specialists, medications, and equipment. Use that list to compare plans on HealthCare.gov, confirming coverage for therapies.

Check that providers are in-network and review the out-of-pocket maximum.

Families whose children attend therapy several times a week often find Silver or Gold plans offer the best overall value. Free help is available at localhelp.healthcare.gov.

Can my child qualify for Medicaid or All Kids in addition to ACA coverage?
Yes. Illinois Medicaid and the All Kids program provide coverage for children who meet income requirements, and some children with disabilities may qualify for Medicaid regardless of income through a waiver program. During Open Enrollment, it’s worth checking both ACA and Medicaid eligibility at the same time. Visit illinois.gov/hfs/MedicalPrograms/AllKids or call Get Covered Illinois for free guidance.

What should I do if my child’s therapy is denied by insurance?
Request a written explanation of the denial. Work with your provider to gather documentation: evaluations, session records, and a letter explaining medical necessity. File a formal appeal and include peer-reviewed research supporting the therapy. Many denials are overturned with persistence. Equip for Equality (equipforequality.org) offers free legal support for Illinois families.

Can I keep my child’s current therapists if I switch ACA plans?
It depends on the plan’s network. Before switching, confirm that every provider your child sees is in-network under any plan you’re considering. If a key specialist is out-of-network, ask about a network gap exception. Some plans will approve continued care without interruption.

What therapies are covered for children with autism under ACA plans?
ACA plans must cover rehabilitative and habilitative services, which includes ABA, speech therapy, occupational therapy, physical therapy, and mental health services. Illinois autism mandates add an extra layer of protection, requiring coverage for ABA and related ASD supports. Always review a plan’s benefits summary to confirm session limits and pre-authorization requirements before enrolling.

This article was originally published in December 2025 and was rewritten in October 2026 to include updated strategies.