How To Make Sure Your Child's ABA Therapy Is Covered By Insurance
Health insurance can be complicated, even more so when ABA therapy is involved. As an accredited ABA therapy provider for more than 20 years, we know exactly what you face as a parent of a child with autism. So, we’ve put together this short guide just for you, outlining key tips, insights, and definitions that can help you find the right health plan for your child’s needs.
Step 1: Find out if your current health plan covers ABA therapy.
There are two types of health plans offered by employers:
- Fully funded/insured health plans, the traditional type of insurance offered by companies, are subject to state mandates that require ABA therapy to be covered. Both Texas and Colorado require ABA therapy benefits in all fully funded/insurance plans offered in their states.
- Self-funded/insured health plans, where your employer becomes your insurance provider instead of a third-party, are NOT subject to the same state mandates as are fully funded health plans. However, a company can choose to cover ABA therapy if it wants.
Unsure if your current health plan offers ABA therapy benefits?
It’s easy to find out. Just call your employer benefits representative or the member services number on your insurance card and ask if your plan includes ABA therapy benefits and what those benefits are.
Step 2: If you need to shop for a new health plan, consider a child-only plan from the Healthcare Marketplace.
Since it’s common for young children with autism to need up to 40 hours of ABA therapy per week, a child-only plan can be a smart financial decision that enables your child to receive the recommended amount of therapy they need to reach their full potential.
You can purchase a child-only insurance plan through the Healthcare Marketplace. The ABA benefit is included in the “Essential Health Benefits” package. This package is required on all Marketplace plans in Texas and Colorado.
Healthcare Marketplace plans can only be purchased during Open Enrollment periods. For 2021, the Open Enrollment period is November 1 – December 15. Selecting a plan during Open Enrollment ensures that you have coverage starting January 1. If you do not purchase a plan by December 15, 2021, the only way you can get coverage is if you have a “qualifying life event”.
Step 3: Eliminate surprises by understanding the costs of your health plan ahead of time.
When looking for the right health plan, make sure to consider the following.
- The deductible. You’ll have to pay this amount before insurance starts to contribute. Your deductible and your responsibility for paying it resets every year.
- You’ll have either a copay or a coinsurance.
- Your copay is a flat rate you’ll have to pay per visit to a provider, including for ABA therapy.
- Your co-insurances in a percentage of the total charges that you will be responsible for paying, after you’ve paid the deductible.
- The out-of-pocket maximum is also important to be aware of. This is the maximum amount you’ll have to pay for the entire year. Once you reach that amount, you won’t have any other out-of-pocket expenses for ABA therapy the rest of the year. Like your deductible, the out-of-pocket maximum also resets every year.
Find a local agent/broker who can provide expert advice on your options and also get you signed up.
Or just email us here at The Behavior Exchange. We’d be happy to help guide you through the insurance process and get your child enrolled in ABA therapy at one of our hives in North Texas or Boulder, Colorado. A brighter future is possible for your child!
Written by Joe’L Farrar, M.Ed., CCC-SLP BCBA
The Behavior Exchange is a Behavior Health Center of Excellence® and an in-network provider.