Brief report: Quantifying the impact of autism coverage on private insurance premiums

J Autism Dev Disord. 2009 Jun;39(6):953-7. doi: 10.1007/s10803-009-0701-z. Epub 2009 Feb 13.


Many states are considering legislation requiring private insurance companies to pay for autism-related services. Arguments against mandates include that they will result in higher premiums. Using Pennsylvania legislation as an example, which proposed covering services up to $36,000 per year for individuals less than 21 years of age, this paper estimates potential premium increases. The estimate relies on autism treated prevalence, the number of individuals insured by affected plans, mean annual autism expenditures, administrative costs, medical loss ratio, and total insurer revenue. Current treated prevalence and expenditures suggests that premium increases would approximate 1%, with a lower bound of 0.19% and an upper bound of 2.31%. Policy makers can use these results to assess the cost-effectiveness of similar legislation.

MeSH terms

  • Adolescent
  • Autistic Disorder / economics*
  • Autistic Disorder / epidemiology
  • Autistic Disorder / therapy
  • Child
  • Child, Preschool
  • Health Expenditures / statistics & numerical data*
  • Hospital Administration / economics*
  • Hospital Administration / statistics & numerical data
  • Humans
  • Insurance Coverage / economics*
  • Insurance Coverage / statistics & numerical data
  • Pennsylvania / epidemiology
  • Young Adult