Open Enrollment 2023: Parent Guide for ABA Therapy Coverage

For most states, the Open Enrollment period starts on November 1st, and runs through January 15th. During this limited period, families can sign up for a new health insurance plan or change to a different plan. This is the right time to make sure that ABA services continue uninterrupted in the upcoming year and are covered under the new insurance plan.

Cost of Autism

If you have a child with an autism diagnosis and are worried about the cost of ABA therapy or have insurance that currently does not cover services, open enrollment is the perfect time to make the switch to an insurance plan that works for your family.

According to the CDC, the average medical expenditures of a child with ASD exceeds those without by $4,110 - $6,200 per year. Costs include health care, education, ASD-related therapy, family-coordinated services, and caregiver time. In addition to these medical costs, intensive behavioral interventions for children with ASD costs $40,000 to $60,000 per child per year.

New to the Insurance Process? Here are some common Insurance Terms you should know.

If you are looking for the best insurance option to cover your child’s ABA therapy, it is important to know some frequently used insurance terms as these can impact your overall costs. Here’s a glossary of more health insurance definitions by

A graphic with a wheel of terms and definitions, in no particular order: Deductible: A set amount of money paid for serviced before insurance starts covering costs. Coinsurance: Percentage of cost paid after deductible is met. Copayment: A fee paid for coverage of services before or after hitting your deductible. Out-of-pocket Maximum: Maximum money you are expected to pay each year for covered services. In/Out of Network: In-network providers negotiate contracts at a discounted rate. Choosing an out-of-network provider can mean higher costs and out-of-pocket. Referral: You might be required by your insurance company to be 'referred' to a diagnosing physician by your primary care doctor.

Making changes to your current plan through your company? Make sure ABA therapy is covered.

Coverage for ABA therapy can vary from plan to plan. It is important to understand your benefits before you make any changes to your current plan.

First and foremost, you need to know if your company’s health plan is self-funded or fully insured. The biggest difference between the two is that self-funded plans fall under federal law and fully funded plans fall under the state mandate. Since there is no federal mandate covering ABA services, it is entirely at the employer’s discretion if they choose to include services in self-funded plans.

Reach out to your HR department to confirm if ABA therapy is included in the plan your company offers.

How to choose the best coverage for ABA therapy? 3 things to consider when selecting a plan!

Categories: There are typically 4 categories of a health insurance plan based on coverage and shared costs – Bronze, Silver, Gold, and Platinum.

Total Cost: It is important to keep in mind your monthly insurance bill (or premium), out-of-pocket expenses, and deductible to get a full view of your total cost.

Plan Types: There are various types of plans that may limit or allow you to see out-of-network providers. The most common plan types are HMO, PPO, POS, and EPO.

What are some of the insurance providers we are in-network with?

At Behavioral Innovations, we accept most major insurance plans, including Texas Medicaid, Oklahoma Soonercare, and Healthfirst Colorado. Here are some of the major insurance providers we are in-network with. For more details and FAQs about insurance, visit our website. If you don’t see your insurance provider listed, please contact us at 855.782.7822 to see if we are in-network with your provider or to discuss additional options.

A grid displaying the logos of insurance providers, including: Optum United Healthcare, BlueCross BlueShield, aetna, Magellan Health, Cigna, Tricare, friday health plans, ComPsych, Humana, Anthem, beacon health options, imagine health, Molina Healthcare, Texas Medicaid, Sooner Care, Health First Colorado

Do you have Texas Medicaid? ABA therapy is now covered.

We are currently accepting Parkland Community Health Plan, Superior HealthPlan, and Amerigroup. If you have Texas Medicaid insurance through these MCOs, contact our intake team to enroll your child in ABA services.

For other MCOs, our team is diligently working through the contracting process with Texas Medicaid. In the meantime, contact our intake team to start the enrollment process, so your child can start services at the earliest.

Questions to ask your Insurance Provider

Below are some questions to ask when inquiring about insurance plans and ABA coverage.

• Is ABA covered by insurance as a benefit for my child?

• Are there certain criteria (e.g., autism diagnosis) that need to be met for coverage?

• What is my premium, copay/coinsurance, deductible, and out-of-pocket?

• Is there a benefit maximum for ABA service?

• Which ABA therapy providers are in-network?

Next Steps

The insurance journey can be daunting. We understand. Our Client Intake Advocates are trained to answer all your questions. We have been serving kids with autism for over 20 years and in that time, have worked with numerous big and small insurance companies to present parents with the best possible plan moving forward. Contact our experienced team to find the insurance plan that works for your family.

Important: If you change your plan, inform your therapy provider as soon as possible to update your records.

Contact Us
Phone: 855.782.7822

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