Insurance

Does my insurance Cover ABA Therapy?

Yes, many insurance plans—including Medicaid in several states—cover Applied Behavior Analysis (ABA) therapy because it’s a proven, evidence-based treatment for children with autism. Coverage details vary depending on your state and your specific insurance plan. In many states, Medicaid covers ABA therapy when a child has an autism diagnosis from a qualified professional and a comprehensive, individualized treatment plan in place.

Private insurance coverage also depends on your plan type and your state’s mandates. Many states require certain insurance plans to cover ABA therapy, though the level of coverage can differ. For example, coverage may be required for employer-sponsored plans, ACA-compliant individual plans, or other fully insured policies. We’re happy to help you understand your benefits and guide you through the process of securing coverage.

The law applies to:

Fully insured large group plans offered by employers with 50 or more employees.
Fully insured small group plans offered by employers with one to 49 employees.
Individual non-grandfathered plans that comply with the Affordable Care Act (ACA) regulations.

Our team is here to guide you through your insurance benefits and offer alternative financing solutions if your coverage is limited.

We know that understanding your insurance coverage can feel overwhelming. Our admissions and insurance team is here to help you navigate your benefits, verify coverage, and explore financing options if your plan doesn’t offer full coverage for ABA therapy.

If your health insurance was purchased before the Affordable Care Act (ACA), your provider is still required to offer you the option to purchase autism treatment coverage. ABA therapy is typically categorized as rehabilitative or therapeutic care and is often covered under benefits for behavioral health, including diagnosis, psychological services, and therapeutic interventions.

Texas Medicaid
Aetna
Blue Cross and Blue Shield
And more depending on your location

Get Started With ABA Therapy at Achieve

Achieve Behavior Centers offers center-based ABA therapy for children aged two to six. As experts in early intervention ABA therapy, we tailor our treatment to offer individualized care, ensuring your child flourishes during the critical learning period of preschool. Get started with ABA therapy by filling out our online form. Our friendly team is available to offer more information about our approach and can assist you in navigating financing options.

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Getting Started

Category of questions on ABA

What is Applied Behavior Analysis (ABA)?

Applied Behavior Analysis (ABA), which is based on the science of learning and behavior, uses a systematic approach to helping your child develop and learn. Principles of ABA can be applied in many areas to help your child, such as (but not limited to) increasing language and communication, improving social and play skills, increasing adaptive skills such as toileting, dressing and feeding, and reducing unwanted behaviors such as tantrums, aggression, or other dangerous behaviors.

There are many strategies that fall under the ABA umbrella, such as Natural Environment Teaching, Discrete Trial Training, Early Start Denver Model, and Pivotal Response Training. At Atlas, we focus on naturalistic, play-based ABA and will individualize the strategies and approach we use for your child based on his/her needs.

Who recommends ABA?

ABA is recommended and endorsed as an effective intervention for ASD by the US Surgeon General, the National Institute of Mental Health, the National Institute of Child Health and Human Development, the National Research Council, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and the American Academy of Neurology, among other national medical organizations and associations.

Is ABA effective?

ABA-based intervention has proven to be the only gold standard therapy for children with autism spectrum disorder. ABA is considered an evidence-based best-practice treatment by the U.S. Surgeon General and the American Psychological Association.

How much ABA is enough?

The Council of Autism Service Providers' practice guidelines advise that children who are under 3 years of age with an ASD diagnosis have greatest outcomes with 25-40 hours a week, and children who are approaching the age of 3 have greatest outcomes with 30 or more hours a week.

When a child is recommended to receive comprehensive ABA treatment (25 hours or more), it is common for this to be challenging for parents to commit to. This is understandable, but research shows that time spent away from therapy can lead to greater skill deficits or behavioral challenges. Receiving intensive services as soon as recommended will give the child a greater chance at reducing the amount of services and time spent in therapies as the child gets older.

A wide body of research shows that intensive ABA services as early as possible leads to the most effective clinical outcomes for children with autism.

How much does this cost?

ABA therapy is considered a medically necessary treatment for individuals with autism spectrum disorder. This means that insurance providers are required to cover the cost of ABA therapy to some extent. However, the amount of coverage can vary widely.

Medicaid covers the full cost of ABA therapy, while commercial insurance providers may only cover a portion of the cost (require a co-pay). Some insurance providers may limit the number of ABA therapy sessions that are covered each year. It is important to check with your insurance provider to understand what your coverage includes. If your insurance provider does not cover the full cost of ABA therapy, there may be other options available to help you afford this important therapy.

Atlas is here to help you navigate your insurance and understand your coverage.

ABA Therapy that Accepts Insurance

The emotional, psychological and financial effects of an autism spectrum disorder (ASD) diagnosis can be far-reaching. However, Achieve is here to help.