How to Obtain Insurance Coverage for ABA Therapy

Families of children with Autism have many day-to-day concerns. At Autism Home Support Services, we realize that managing and/or obtaining insurance coverage for medically necessary therapies is one of the biggest. Our experienced insurance team will assist you in determining your current Autism benefits.

Thanks to the efforts of Autism Speaks and other local advocates, 37 states have passed Autism Mandate Laws in the past 10 years. This advocacy work continues, with Autism Speaks leading the way. Although they vary by state, in general, these mandates guarantee coverage for Applied Behavior Analysis (ABA) and other therapies for families who have a “fully insured” insurance policy, such as an individually purchased policy or a small employer group policy. However, the majority of families (approximately 60% of the insured population) that have a large employer self-funded policy are left out of this mandate and are without coverage for much needed therapy. Fortunately, there are options that families without coverage can pursue.

Advocating to your self-funded employer

Recently, some of the large employer-based health plans that are self-funded have elected to cover ABA therapy. The best way to affect this change is for employees to approach their employer about covering ABA therapy. Those who choose to speak with their employer can receive assistance from Autism Speaks, who has published a toolkit and will even provide an advocate to come and meet with your employer (www.autismspeaks.org/advocacy/insurance).

Benefits of the Affordable Care Act

• The ACA has made buying individual policies extremely affordable and easy.
• Families enrolled in a self-funded plan that excludes ABA therapy can now take their child off of the corporate policy and buy an individual policy for the child without jeopardizing the corporate benefits for the rest of the family.
• The ACA ends pre-existing condition exclusion for children.
• To read about Autism Speaks’ assessment of the ACA, click here.

If you are interested in purchasing such a policy, you can go to www.getcoveredillinois.gov or contact a local insurance agent. You can also download information from our insurance workshop.