Check ABA Therapy Insurance Coverage in Your State

Understanding insurance coverage for applied behavior analysis (ABA) therapy for children diagnosed with autism spectrum disorder (ASD) can be overwhelming. Each state and insurance plan varies, which is why Action Behavior Centers has created a user-friendly state-specific insurance checker tool. This tool helps families quickly understand their coverage options for autism therapy, allowing them to take the next step with confidence.

Start with our insurance checker

You can find our insurance checker tool here. If your insurance isn’t listed, don’t worry! We accept over 120 insurance plans and are continually adding more. Feel free to contact your local Action Behavior Centers team to verify your coverage.

Does insurance cover ABA therapy?

Navigating insurance is often a major concern for families when their child is diagnosed with autism. Key questions include:

• What autism services does insurance cover?
• What are my expected out-of-pocket costs?
• How many ABA therapy hours are covered?
• Is financial assistance available?

At Action Behavior Centers, we aim to simplify this process, allowing you to focus on your child's individualized goals. Most families are pleased to find that their insurance, including many Medicaid programs, covers ABA therapy. In fact, every state where we operate mandates insurance companies to provide some level of coverage for autism services. Our knowledgeable insurance specialists are available to guide you through each step, including:

• Insurance verification: We confirm your child’s ABA therapy coverage, deductible, and out-of-pocket costs with your insurance provider.
• Pre-authorization support: Many insurance plans require prior authorization before a child diagnosed with autism can begin services to ensure that the services are medically necessary. We handle all necessary paperwork for this.
• Direct billing: We bill your insurance company directly after each session, relieving you of managing claims.

Understanding in-network ABA coverage

Action Behavior Centers is in-network with many of the largest insurance providers in the states we serve. This means we have agreed-upon rates with those plans. For families, this usually means lower out-of-pocket costs compared to if you received out-of-network care.

Your total cost for ABA therapy depends on your plan’s deductible and maximum out-of-pocket (MOOP). MOOP is an agreed-upon rate by the insurance company that outlines the most your family will pay for covered healthcare services in a year. Once that amount is reached, your insurance typically covers 100% of the remaining costs for the rest of the year.

Is there financial assistance for ABA therapy?

We offer several financial assistance programs to help families reduce barriers to accessing medically necessary ABA therapy:

• Charity Care Program: Families qualifying under federal poverty guidelines may receive financial assistance based on income level.
  
  
• Sliding-Scale Payment Options: For eligible families, we provide payment options based on income, helping you understand what assistance might be available.

How much does ABA therapy cost with insurance?

The cost of ABA therapy depends on your child’s needs, your insurance plan, and where you live. Many families discover that insurance covers most or all costs, especially after meeting their deductible or out-of-pocket maximum for the year.

What affects the cost of ABA therapy?

• Insurance plan details: Deductibles, copays, and coverage limits.
• Recommended therapy hours: Based on individualized goals set by a Board Certified Behavior Analyst^® (BCBA^®).
• Location: Rates can vary by state and region.
• Provider qualifications: Services overseen by a BCBA.

How many hours of ABA therapy are covered?

The number of hours covered depends on your child's unique needs. Before ABA therapy begins, a BCBA conducts a comprehensive assessment to create tailored goals in collaboration with your family. Our team then verifies how many ABA therapy hours are covered by your insurance and helps you understand any remaining costs.

What if insurance doesn’t cover everything?

If your insurance approves fewer hours than recommended by a BCBA, we can submit an appeal on your behalf. We will also discuss financial assistance options to ensure your child continues to reach meaningful outcomes.

In most cases, families must meet their deductible, copays, or coinsurance amount until they reach their maximum out-of-pocket amount. After that, insurance often covers the full cost of care for the rest of the year.

Insurance support for ABA therapy at Action Behavior Centers

Insurance doesn’t have to be confusing. Use our insurance checker to get started, or contact your local Action Behavior Centers team. We’ll help you navigate your insurance coverage, schedule an autism evaluation if needed, and get your child started with ABA treatment as soon as possible.