Habilitative/Habilitation Services - Health Insurance

What Are Habilitative/Habilitation Services in Health Insurance?

<lingo>Habilitative/habilitation services are health care services that assist individuals with learning, improving, or holding onto basic daily skills and functions. These services help individuals initially establish these skills and functions because they were never initially acquired at an age-appropriate level. For a variety of reasons, on-time development may have been delayed. Most often, qualified individuals in need of habilitative services were unable to acquire age-appropriate skills and functions because of a physical or intellectual disability. Services may, for example, be provided to a child who is not talking or walking at the expected age or children or adults with autism or cerebral palsy.</lingo>

Habilitative/Habilitation Services Clearly and Briefly Explained

There are a variety of services that may be necessary for someone who requires habilitative/habilitation services. For example, speech language pathology, occupational therapy, audiology, ABA therapy, physical therapy, psychology, and other such treatments are all considered under the umbrella of habilitative services. Delivery of these services may be outpatient or inpatient in a variety of settings.

Habilitative/habilitation services are similar to rehabilitative/rehabilitation services, but the two are not exactly the same.

Whereas habilitative services help individuals learn new skills and functions for the first time, rehabilitative services help those who have lost skills or functions because of an injury, illness, or new disability. These latter services are often designed to assist those who did develop the age-appropriate daily living skills and functions at one time, but who lost them or had them impaired due to an injury, illness, or disability. 

<twitter>Habilitative/habilitation services are health care services that assist individuals with learning, improving, or holding onto basic daily skills and functions. </twitter>

Despite being in a different category of health care services, rehabilitative services often include the same list of services under the habilitative umbrella: speech language pathology, occupational therapy, physical therapy, etc. Rehabilitative services are often called “rehab” services.

The reason for differentiating between these two types of services usually comes down to health insurance coverage. In the past, insurance plans were much more likely to cover rehabilitative services and rarely covered habilitative services. However, according to the Affordable Care Act’s list of essential health benefits (EHBs), which must be covered by insurance plans, “Rehabilitative and habilitative services and devices” are #7. 

Still, “habilitative services” is a term that’s open to some interpretation, and not all plans offer the same level of coverage for this category of services.

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