Is ABA Therapy Covered by Insurance?

If you're exploring applied behavior analysis (ABA) therapy for your autistic child, insurance is usually the first question on your mind. Will your plan cover it? How many hours are included? What will you actually pay out of pocket?

The short answer is that yes, most insurance plans cover ABA therapy for children diagnosed with autism spectrum disorder (ASD). The longer answer depends on your state, your plan, and your child's diagnosis. Here's what to know before you make that first call to your insurance company, plus how to check your coverage in minutes.

What is ABA therapy for autism?

ABA therapy is an evidence-based treatment for children diagnosed with autism spectrum disorder. It uses the science of learning and positive reinforcement to help children build practical skills for everyday life. At Action Behavior Centers, every child works with a dedicated team led by a Board Certified Behavior Analyst® (BCBA®), who sets individualized goals in collaboration with families after thoroughly assessing their needs.

ABA therapy can help children build skills such as:

• Communication skills: Building verbal and nonverbal communication, like speaking, making eye contact, and understanding others
• Social interaction: Practicing turn-taking, playing with peers, and starting conversations
• School readiness skills: Learning preacademic skills like matching, sorting, and following instructions
• Independence skills: Washing hands, following directions, routines that support independence in everyday activities
• Behavior support: Addressing the root causes of unsafe behaviors like self-injury and aggression by teaching safer, more effective ways to meet their needs

Progress is tracked with ongoing data, and goals are adjusted as your child grows. 

Does insurance cover ABA therapy?

Yes, ABA therapy is covered by most insurance plans. Under the Affordable Care Act (ACA), most health plans are required to cover autism services, including ABA therapy, for children with a documented ASD diagnosis. On top of that, every state ABC serves—Arizona, Colorado, Illinois, Indiana, Minnesota, North Carolina, Pennsylvania, South Carolina, and Texas—has its own autism insurance mandate that requires many health plans to cover autism diagnosis and treatment.

Private insurance for ABA

Many major insurers, including Blue Cross Blue Shield, Aetna, Cigna, and UnitedHealthcare, cover ABA therapy for autistic children. ABC is in-network with 120-plus insurance providers across the states we serve, and being in-network typically means a lower out-of-pocket cost for your family than going out-of-network. Check if we accept your insurance plan.

Employer-sponsored plans for ABA

Most job-based health plans include some level of ABA therapy coverage. The specifics depend on your employer and your insurance carrier, so it's worth calling the number on the back of your card to confirm.

What affects your ABA therapy coverage?

An autism diagnosis

Most insurance companies require a formal ASD diagnosis before they'll cover ABA therapy. If your child doesn't have one yet, ABC offers no-cost diagnostic support, including online screeners and professional autism evaluations such as the ADOS-2 and the Initial Diagnostic Evaluation (IDE), to help you take that next step.

Age and hour limits

Some plans cap ABA therapy by age or by the number of approved hours. Many policies cover care through age 21, though approved hours vary by plan. Our teammates review your specific plan with you so there are no surprises.

Where and by whom therapy is provided

Most plans require that ABA therapy be delivered by a licensed or certified professional, such as a BCBA, and some specify a setting, whether that's center-based ABA therapy, ABC at Home, or after-school ABA support.

How to verify your ABA therapy insurance coverage

If you’re not sure whether your insurance covers ABA therapy, here are some simple steps you can take:

1. Call your insurance company. Ask whether your plan covers ABA therapy for autism, whether there are age or hour limits, and whether you need a referral before starting.
2. Get a formal diagnosis. Most insurers require documentation from a licensed provider. If you need help getting there, ABC's no-cost diagnostic support can guide you through screening and evaluation.
3. Review your benefits. Look at your deductible, copay, coinsurance, and maximum out-of-pocket (MOOP), the most your family will pay for covered care in a year before insurance covers 100% of the rest.
4. Don't give up after a denial. Denials sometimes happen because of missing paperwork or a billing code error. Keep records and follow your insurer's appeal steps.

You don't have to do this alone. ABC's insurance specialists verify your child's benefits, handle pre-authorization paperwork when it's required, and bill your insurance company directly after each session.

What if my insurance requires prior authorization?

Some plans require prior authorization before ABA therapy can begin to confirm that treatment is medically necessary. Here's what that typically looks like:

1. An ABC clinician completes a thorough assessment of your child's needs and your family's goals, then recommends an appropriate number of therapy hours.
2. Our insurance team compiles documentation and submits the request to your insurance provider.
3. The insurer reviews the request, which usually takes 7 to 14 business days.
4. You receive an approval, or if the request is denied, our team works with you on next steps, which may include filing an appeal.

If your insurer approves fewer hours than recommended, ABC will appeal on your behalf and talk through financial assistance options so your child can still get the support they need.

Check your coverage and take the next step

Insurance questions don't have to hold up your child's care. ABC's insurance specialists are ready to help you understand your benefits, your out-of-pocket costs, and what happens next. Check your insurance coverage now.

If you're not yet sure whether your child's development points to autism, ABC's no-cost online screener can help you take the next step toward answers. Take a no-cost online autism screener.