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Real members of MyAutismTeam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

How Much Does Insurance Covering ABA Cost?

How Much Does Insurance Covering ABA Cost?

We are planning to move to another state where there's mandatory coverage for individuals with autism. I saw one poster who said it's about $10,000/year when you add the deductible and copays up. I know states have ACA/Obamacare or other laws but I wonder about the waiting lists and if any therapists will accept it. Yeah, there are Medicaid waivers or a good school district but so far I'm not thrilled the Medicaid route (it's better than nothing) and I'm I assuming better school districts may… read more

A MyAutismTeam Member said:

I don't know if this helps anyone, but...There are some large companies with self-funded plans that cover Autism. I work for UTC and we started covering it in 2014 (at all our US based companies) OT, PT, speech and the biggie, ABA. I know lots of the high tech companies cover it, as do Home Depot and Wells-Fargo. Perhaps switching companies wouldn't be as hard as moving? Not sure, but worth a look. Also, if anyone wants to try and think about showing their company why they should cover it, I am happy to help out. I worked very closely with UTC to have our coverage expanded for 2014. The costs aren't nearly as high for a pooled insurance risk as companies think, so that is the angle you have to work. We live in SC so we have the blessing of Medicaid, Ryan's law, and my company's coverage.
Good luck everyone. My heart goes out to you all. We were looking at the possibility of bankruptcy before we got the coverage we needed for our two kids.

posted about 7 years ago
A MyAutismTeam Member said:

I live in Indiana. We received a grant for 10,000, this went toward my son who was 4 to attend ABA. He attended 2 days a week approx 16 hrs a week. 10,000 lasted 3 months!! We were told by the time his grant ran out they should be able to accept Medicaid. It's been a year and they still cannot accept Medicaid. I spoke with a insurance specialist the ABA center uses and he said he didn't know a center in the entire state that accepted Medicaid. I'm absolutly beside myself. I feel it's a necessity for my sons adulthood. I'm willing to move states, whatever I need to do for my son to have the best chances at an independent life. It breaks my heart that I can't get any direct answers. Everyone I talk to tells me something differant. They keep saying 'soon' as my son continues to get older. I feel I'm in a race for time. I need help badly!!!!

posted about 7 years ago
A MyAutismTeam Member said:

I live in Illinois and we have regular medical coverage thru my husband's insurance, he is a state employee. However, what I did was contact ABA therapists and find out the best insurance in regards to the services we needed. We purchased our son a separate policy thru the marketplace(Obamacare) and that became his primary policy.. Apparently, all the marketplace plans must cover ABA. We have Aetna PPO that we pay for separately. Our son receives about 30 hours a week and it's 100% covered minus our deductible that we paid out of pocket. Aetna did require a lot of documentation, medical reports, medical diagnostic report as well as all of his history from early intervention, but they do cover it. The marketplace opens up again November 15th and we plan to check into BCBS on the marketplace as the billing company that handles the billing for his therapist said it's a much more streamlined process at BCBS. Our son is 3 and goes full time but they do have other kids that they see from the local school districts. Hope this helps.

posted about 7 years ago
A MyAutismTeam Member said:

We have self-funded through my husband's company--47% of companies nation-wide including some very large corporations are self-funded where the company takes on the insurance risk instead of the insurance company, and thereby they dictate what is covered and what is not. Anything autism related is denied even though we live in Illinois where there is an autism law. We pay $6000 a year out of pocket for a couple hours of ABA each week and have to rely on what our school district provides for the rest of our services--it makes it tough knowing that if we had the right insurance plan with a different company our son could get so much more.

posted about 7 years ago
A MyAutismTeam Member said:

I have congestive heart failure and insulin dependent diabetes and a 5 year old daughter with ASD. Heart failure has better coverage than ASD with our company's self funded policy. For this reason, we have found out of pocket costs to be similar (about $5,000 per year per person, plus cost of insurance premiums and any co pays for surgeries, etc), despite me taking about 15 prescription drugs everyday. However, Dani has not received ABA yet, as not covered for us. We are looking at maybe a Humana Platinum plan next year, Cigna Gold in Admin function turning down autism for most needed therapies. She is getting speech and OT 1 hour per week now. The new policy may allow us a $15 copay for therapies, as opposed to $40, or 100%. ABA looks like a 20 % copay, with policy running about $174 per month. We are far above income to qualify for subsidies in TX, but at least coverage may be available with the ACA now. If ABA is covered, will be huge. Better off even if not, though. $0 deductible plan.

posted about 7 years ago
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