Choosing Health Insurance: What Parents of Kids with Autism Need to Know

Choosing Health Insurance: What Parents of Kids with Autism Need to Know

Halloween is upon us! But, the open enrollment period for the Health Insurance Marketplace begins on Saturday, and choosing the best health insurance plan for your family can be what really gives you a fright this time of year.

Whether you’re new to the Health Insurance Marketplace or need to review your current plan and options for 2026, here are important details to know and steps to take to ensure your child with autism has access to the support and services they need next year, including ABA therapy.

About the Health Insurance Marketplace

The goal of the Health Insurance Marketplace is to make health insurance more affordable for more people. The first thing you have to do is see if you’re eligible for a plan through the Marketplace. Many people are eligible.

  • There is no income limit.
  • Insurers cannot refuse coverage based on sex or a pre-existing condition.
  • There are no lifetime or annual limits on coverage for essential health benefits.
  • Young adults can stay on their family’s insurance plan until age 26.

The cost of insurance through the Marketplace may depend on where you live, your income, and the size of your household.

  • You may qualify for a subsidy that will lower your monthly premium.
  • You may also have to pay out-of-pocket costs, including deductibles, coinsurance, and copayments.

With a few exceptions, there is only one time of year when you can secure insurance coverage through the Marketplace. It’s called the open enrollment period, and it’s the same time every year: November 1 – January 15.

  • Sign up for a plan by December 15 if you want coverage to start on January 1, 2026.
  • If you miss the December 15 deadline and end up signing up for a plan by January 15, 2026, your coverage won’t start until February 1.
  • You must also pay your first month’s premium to activate your coverage.

Health Insurance Marketplace Tips for Parents of Children with Autism

The most important tip is not to wait, thinking you have a month and a half to choose an insurance plan or renew your current one. It may seem like a long time, but it really isn’t. Also,  if you’re planning to renew your current insurance plan on the Marketplace, please note that your premium could go up in 2026, because the extra financial help that was put into place as a result of the pandemic expires this year.

Here are more tips to keep in mind when securing a health insurance plan for your family and kiddo with autism:

Tip #1 – Gather up your documentation now. This step will save you time and prevent the last minute scramble. Create a folder, the paper kind or on your desktop, and drop in files such as details about your current insurance plan, your child’s diagnosis and evaluations reports, and any therapy invoices or summaries for 2025.

Tip #2 – Assess how your current insurance plan met or didn’t meet your needs. Did your current insurance plan offer coverage for ABA therapy, the gold standard in autism care? Did it offer only a limited number of hours when your child required more? Did it offer a wide selection of in-network ABA therapy providers to choose from? Was the deductible too high? Not all insurance plans cover ABA therapy services equally. Be sure to look for plans that use specific language, like “Behavioral Health Treatment” and “Autism Services.”

Tip #3 – Compare plans on the Marketplace. Starting Saturday, November 1, you can go here to compare plan and prices without logging in or applying for coverage. Things to know:

  • Plans come in four categories (Bronze, Silver, Gold, and Platinum) with varying levels of coverage and costs, which could affect access to autism services for your kiddo.
  • Make sure the plans you compare include your current health care service providers in their network.
  • Look for what your out-of-pocket will be before your insurance starts covering your child’s ABA therapy and other services.

Tip #4 – Confirm your healthcare providers are in-network with the plan you want. Even if medical professionals, like an ABA therapy provider, accept insurance from a particular company, that doesn’t mean they’re in-network with every plan the insurance company offers. It’s best to call them and the insurance company to confirm you will have coverage for the services your family and child need.

Tip #5 – Ask your ABA therapy provider for help. They should know all about insurance and can answer your questions when it comes to specific companies, plans, and enrolling on the Health Insurance Marketplace. Here at The Behavior Exchange, we advocate for families with their insurance company and actively take steps to ensure every child receives all the ABA therapy hours they medically need.

If we can help with anything, don’t hesitate to reach out.

We want you to start off the new year with the right insurance plan as well as a plan for a brighter future through highly accredited and individualized ABA therapy. Contact our team of experts today!

We hope you found this blog full of helpful information! Share it with your family and friends on your social media!

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Ashvina attended University of Bombay and graduated with a Bachelors of Commerce. She got her Montessori Diploma in 1985 and taught ever since. Ashvina came to TBE in January of 2016 as Admin Assistant. During the years she got the opportunity to learn and work in different departments such as HR, Finance, Office Manager and Executive Assistant. Last summer TBE bought billing in house and her current focus area is Revenue Cycle Management. She is detail oriented and enjoys working with people. Ashvina volunteers to deliver meals to seniors and local shelters on the weekend. She loves to spend time with her family and grandkids. Ashvina loves her job because she enjoys hearing different points of view, and she feels her contributions help fuel the direction of our company.

Working with children comes naturally to Angela. Her mom was a special education teacher for 30 years and often had Angela join her for Take Your Child to Work Day. And in high school, Angela spent every summer as the nanny for a little boy with an autism spectrum disorder. It was this experience where her passion for working with children with autism started to blossom.

From there, she went on to graduate from Oklahoma State University with a Bachelor of Science in Human Development and Family Sciences. She learned about Applied Behavior Analysis (ABA) in a non-normative development class and from that moment knew that ABA would be her life’s work.

Angela moved to the DFW area shortly after and began working at The Behavior Exchange as a therapist. She worked on her Master’s in Behavior Analysis at the same time. A year after graduating, she earned certification as a Board Certified Behavior Analyst.

Now, as a Clinical Director at The Behavior Exchange, she brings a life-long passion to her work, holding a special place in her heart for children with limited language skills and working closely with families to develop healthy sleep habits.

Danielle’s passion for working with families is deeply personal and from the heart. Her younger brother has an autism spectrum disorder, and through their journey as a family, she found her purpose in life as an advocate for individuals with special needs.

After graduating from the University of North Texas with a degree in Human Development and Family Studies, Danielle began volunteering at The Behavior Exchange. She saw passionate therapists, meaningful change for clients, and families with hope for the future. After a summer of volunteering, she officially joined the team as Director of Admissions and found her home with The Behavior Exchange family.

With her extensive experience working as a client advocate with insurance providers, Danielle perseveres to help individuals of all ages and abilities receive the services they need to reach their full potential. She feels truly honored by each and every family who entrusts The Behavior Exchange to be part of their journey and is committed to the organization’s core values, mission, and goal of being a beacon of hope for the community.

Adam has always had a passion for helping individuals of all ages thrive and reach their full potential. He’s also an enthusiastic musician, songwriter, leader, and devoted family man, who has been helping children and team members grow with The Behavior Exchange since 2010.

Prior to joining the team at The Behavior Exchange, Adam was a mortgage loan consultant and grad student, pursuing his master’s degree in Education at the University of North Texas. He graduated in 2013 and also earned a graduate academic certificate in Autism Intervention. The following year, after years as a Behavior Therapist and seeing first-hand the power of ABA and the meaningful impact it can have on children and their families, Adam became a Board Certified Behavior Analyst. He then commenced from the Stagen Leadership Academy after completing the Integral Leadership Program (ILP), a 52-week practice-based program designed to develop executives serious about transforming themselves, their teams, and their organizations.

Adam is truly grateful to be a part of a dynamic, inspiring and compassionate team, and he’s dedicated to bettering the lives of all children and their families through the delivery of the highest quality of ABA services, while supporting the amazing team at The Behavior Exchange.

Soraya is from South Africa and moved to Texas in 1996. She graduated from The University of Texas and pursued a career, at that time, in Education. Soraya taught at a Montessori school for a few years and then took on a leadership role.

During her time in the education system, Soraya realized her passion was to assist children with special needs. So she joined The Behavior Exchange as a therapist, transitioned into a supervisory role in 2017, and a year and a half later, was promoted to Clinical Operations Manager.

She quickly learned the ins and outs of ABA operations and scheduling and successfully collaborates across departments to ensure The Behavior Exchange continues to provide quality services to clients and their families. She’s thankful to be part of such an amazing organization and excited to see what the future holds.

You could say Walter’s career started when he spent hours as a young child drawing superheroes and coloring maps. This passion, along with extraordinary swimming skills, landed him a full swimming scholarship at Texas Christian University, where he graduated in 1997 with a Bachelor of Fine Arts in Communication Graphics.

During the next 13 years, his design and art direction skills, conceptual-thinking abilities, and marketing-savvy know-how were honed at a few prestigious advertising and marketing agencies around the Dallas area. In the mid 2000s, he helped his wife Tammy Cline-Soza (founder and CEO of The Behavior Exchange) create a unique and concise brand for her new business. From logos and websites to uniforms, brand voice and visuals, Walter has been the main creative force for all things The Behavior Exchange.

Aside from giving birth to The Behavior Exchange brand, Walter is helping Tammy raise two amazing, beautiful children, River and Sierra. In his spare time (the two minutes he’s got per week), you can find Walter illustrating iconic landmarks of Dallas and Texas or looking around for this next open-water swim. Once he gets back in shape.

After 20 years of building The Behavior Exchange, literally from the ground up,
Tammy couldn’t be more proud of the team, culture, and organization that it has become.

As a family helping families, The Behavior Exchanges looks for opportunities that will make the biggest impact and produce life-changing outcomes – for clients, families, and even for team members. Tammy believes that if a team, a family, a community takes care of each other, the possibilities are endless and the relationships built along the way can make life more enriching and challenges easier to navigate. You could say her goal has been to build a kind of utopia full of support, love, and expertise that brings the best services possible to the community and ensures more families have access to those services.

Tammy and her family have dedicated their lives to the mission of The Behavior Exchange and continue to grow, learn, cultivate, challenge, support, and create better models for success. To that end, she is committed to her own leadership development and actively participates in advanced training, mentoring, and deep self-exploration on how to live out her purpose to love and support her family and help others reach their full potential. She takes her position very seriously and tries to serve as a channel for what the universe wants to come to fruition.

She also loves travel, gardening, being creative, MUSIC!, tennis, yoga, meditation, journaling, reading, being in nature, adventures, and more than anything, spending time with her husband Walter and their two beautiful children, River and Sierra.