DOES INSURANCE COVER ABA THERAPY FOR ADHD

DOES INSURANCE COVER ABA THERAPY FOR ADHD

DOES INSURANCE COVER ABA THERAPY FOR ADHD: Navigating your insurance benefits can be confusing and overwhelming. We often hear questions like, “Does my insurance cover applied behavior analysis (ABA) therapy for my child?” or, “I just don’t know who to contact to find out if we have any benefits or what to ask when I call.” Hopefully, this blog post will help answer some of your questions about the benefits of ABA.

Does Insurance Cover ABA Therapy For Adhd?

The good news is that ABA therapy is likely covered by your insurance plan. Most insurance plans cover autism therapy, including ABA therapy and autism assessments. Coverage varies by location and plan, so check with your carrier.

How Much Does ABA Therapy Cost Without Insurance?

ABA therapy costs between $62,400 and $249,600 per year without insurance coverage.

Monthly costs for ABA therapy can range from $4,800 to over $20,000 per month without insurance coverage.

Weekly costs for ABA therapy start at $1,200 and can go up to $4,800 without insurance coverage.

However, don’t be put off by these prices, your insurance company will likely cover these costs. The table below shows how much insurance pays for ABA therapy:

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Time and costs without insurance

  • Per year: $62,400 to $249,600
  • Per month: $4,800 to over $20,000
  • Weekly: $1,200 to $4,800
  • Per day: $240 to $600
  • Hourly: $120 to $150

How do insurance companies cover ABA?

Your ABA coverage may vary from state to state and plan to plan. Some insurance companies cover ABA quickly, but others are much more conservative in their coverage. Each insurance plan comes with a brochure explaining the plan’s coverage.

However, the terminology and language used are technical and can be difficult to understand.

But don’t give up, dig deeper and you’ll find information about whether or not your plan includes applied behavior analysis.

If you don’t see that information or aren’t sure how to interpret the plan, call the customer service number on your membership card and ask the insurance company’s support team. The table below explains how insurance companies cover ABA.

Here’s an overview of the side-by-side plan comparison:

Insurance ProviderDescription
MedicaidAs of February 2022, all 50 states have implemented Medicaid insurance coverage for autism treatment. Read our Medicaid insurance coverage guide to learn more.
CignaSome plans cover ABA. If you have a Cigna plan, your doctor must submit formal ASD diagnosis paperwork before therapy begins.
Blue Cross Blue ShieldEvery plan is different under this label. For example, ABA is covered for people younger than 18 in Michigan. Some plans require preauthorization or paperwork before therapy begins.
Kaiser PermanenteKaiser was the first company in Oregon to voluntarily cover ABA in 2012. However, not all states offer that coverage. For example, some plans don’t include coverage in Washington.
AetnaAetna does not explicitly cover ABA therapy, but it could be allowed. Speak with the company about if you could qualify for coverage.

Autism Insurance Coverage by the State

The American Speech-Language-Hearing Association collected data on a list of states. Here is an example list:

  1. California: If a plan covers physical treatments, that plan must also cover mental health services. The good news is that ABA therapy is considered a covered autism treatment.
  2. Indiana: ABA therapy is not explicitly covered here, but therapy for autism and related disorders may not be subject to limits or deductibles.
  3. Georgia: ABA therapy is not explicitly covered here.
  4. Montana: ABA is not explicitly mentioned. Autism treatments can be limited to $50,000 per year for children ages 8 and under.
  5. Arkansas: ABA therapy is covered when delivered by a licensed, board-certified expert.
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The following states have specific autism mandates, requiring certain insurers to provide coverage for autism spectrum disorders.

AlabamaNorth CarolinaKentucky
AlaskaOhioLouisiana
ArizonaOklahomaMaine
ArkansasOregonMaryland
CaliforniaPennsylvaniaMassachusetts
MichiganColoradoRhode Island
South CarolinaMinnesotaConnecticut
DelawareSouth DakotaMississippi
MissouriTexasDistrict of Columbia
FloridaUtahMontana
GeorgiaVermontNebraska
NevadaHawaiiVirginia
IllinoisWashingtonNew Hampshire
New JerseyIndianaWest Virginia
WisconsinNew MexicoNew York
KansasIowa

Insurance Companies Covering ABA Therapy

These are some of the well-known insurance companies that can cover the cost of ABA therapy.

If you are looking for the best health insurance for ABA therapy, then the list below should be of value. Visit the attached links to learn more about each insurance company’s coverage for autism treatment.

  1. Medicaid -> Read More
  2. Aetna -> Read More
  3. Cigna -> Read More
  4. UnitedHealthCare -> Read More
  5. BlueCrossBlueShield -> Read More
  6. Kaiser Permanente -> Read More
  7. Anthem -> Read More

How many people have ABA therapy covered by health insurance?

At least 200 million people now have health insurance for ABA therapy. For the past decade, the AutismSpeaks.org advocacy team has focused its efforts on improving health insurance coverage for medically necessary treatments such as ABA.

Self-Funded vs Fully Funded ABA Therapy Insurance Plans

The laws surrounding insurance plans can be confusing. For example, AutismSpeaks.org says there are two types of insurance plans in the United States, with fundamentally different types of coverage. You may not know what kind of plan you have, and that’s okay. Many people don’t know, but some tools can help you find out.

  • Self-Funded Plans: A self-funded plan must comply with federal law, but not state versions. Your employer ultimately decides what the insurance does and does not cover.
  • Fully Insured Plans: A fully insured plan must provide benefits under state law, and your insurance company will determine what is and is not covered.
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Knowing the type of plan you have can help you better understand what benefits you have and what is covered, and you can be more confident in choosing an insurance plan to cover autism treatment.

Your state may not explicitly support coverage for ABA therapy, but chances are your state will require coverage for autism. In either case, the benefits vary considerably depending on where you live.

Questions to ask your health insurer

Here are some questions you can (and should) ask your insurance company to learn more about how much coverage you have when starting ABA therapy:

  1. Is ABA therapy reimbursed by my insurance as a benefit for my child?
  2. How Much Does My Insurance Cover ABA Therapy?
  3. How long/how many therapy sessions are allowed?
  4. What is my coinsurance or copay?
  5. How old can my child be reimbursed for ABA therapy?
  6. What criteria are needed to cover ABA therapy?
  7. Do I need to submit a specific autism diagnosis or documentation?
  8. What is my own or my family’s deductible for ABA therapy?
  9. Which specific ABA therapy providers are present in the network? Does CrossRiverTherapy cover?
  10. DOES INSURANCE COVER ABA THERAPY FOR ADHD?

DOES INSURANCE COVER ABA THERAPY FOR ADHD?

Most insurance companies only cover ABA therapy with a diagnosis of autism. Also, some insurance companies require a letter from your child’s treating physician stating why ABA therapy is medically necessary. So be sure to ask your insurance adviser whether you need a letter to start the treatment.

Does insurance cover autism testing?

Some insurance companies may cover autism testing, but coverage depends on your location and plan. To better understand how insurance can cover ABA, read our insurance guide to ABA therapy.