Does Medicare Cover Autism Testing for Adults

Last Updated on August 23, 2025 by John Hookway

You might wonder, does Medicare cover autism testing for adults in 2025? Medicare can help pay for autism tests if your doctor recommends them.

However, therapy like ABA is not covered for adults. According to the CDC, about 2.18% of adults in the U.S. have an autism diagnosis in 2025. If you need assistance, you are not alone—many adults seek answers and support.

Key Takeaways

• Medicare Part B helps pay for autism tests for adults if a doctor orders them and says they are needed.
• Medicare does not pay for autism therapies like ABA for adults, but some Medicare Advantage plans may give extra help.
• You must follow Medicare rules, like age or disability, and show you need the test to get autism testing covered.
• You pay monthly premiums, deductibles, and part of the test cost. Medicaid or extra plans can help lower your costs.
• Talk to your doctor and Medicare plan before testing to check coverage and get the right papers and referrals.

Does Medicare Cover Autism Testing for Adults

What’s Covered

You might ask if Medicare pays for autism testing for adults. Medicare can help pay for some autism tests if your doctor says you need them.

These tests can be diagnostic evaluations, psychological testing, or neurodevelopmental assessments. Your doctor has to order these tests for Medicare to help pay.

Medicare Part B usually helps with these outpatient services. After you pay your deductible, Medicare pays 80% of the cost. You pay the rest.

Medicare Advantage plans, called Part C, might give extra benefits. Some plans may cover more autism services than Original Medicare.

Here is a table to show what each part of Medicare covers for autism testing in 2025:

Ask your doctor if the test is needed and if Medicare will pay for it.

What’s Not Covered

Medicare does not pay for every autism service. If you ask, “does Medicare cover autism testing for adults,” you should know that Medicare does not pay for therapies like applied behavior analysis (ABA) for adults.

Original Medicare also does not pay for other autism treatments or therapies. Some Medicare Advantage plans might offer ABA therapy, but this is rare.

You cannot use Medicare to pay for autism testing for kids. Medicare does not have special plans just for people with autism.

But if you have other health problems with autism, you might get extra help through chronic care management.

Here is a list of services not covered by Original Medicare for adults with autism:

• Applied behavior analysis (ABA) therapy
• Autism-specific therapies or treatments
• Autism testing for children

Plan Differences

You can pick between Original Medicare (Parts A and B) and Medicare Advantage (Part C). Each plan works in its own way.

Original Medicare pays for basic outpatient testing if your doctor orders it and says you need it. You pay a monthly premium, a yearly deductible, and 20% of the cost after the deductible.

Medicare Advantage plans are from private companies. These plans must cover what Original Medicare covers, but some plans add extra benefits. Some Medicare Advantage plans may pay for more autism services, like certain therapies or extra mental health help.

Coverage, costs, and rules can change based on where you live and which plan you pick. Some plans may want you to get a referral or approval before testing.

Always check with your plan before you set up any testing. Ask if you need a referral or approval first.

If you still wonder, does Medicare cover autism testing for adults, remember that coverage depends on your plan, where you live, and your doctor’s advice. Always talk to your doctor and your Medicare plan to make sure you know what is covered.

Eligibility and Requirements

Who Qualifies

You might wonder if you can get Medicare for autism testing. Medicare has rules about who gets these benefits. You must be a U.S. citizen or a legal resident.

Most people get Medicare when they turn 65. Some people younger than 65 can get it if they have a disability that Social Security accepts. Just having autism does not mean you can get Medicare. You must meet the main Medicare rules.

Here is a simple table to show who can get Medicare:

If you want to know if Medicare covers autism testing for adults, check if you meet the age or disability rules first. Your insurance plan might also have other rules.

Medical Necessity

Medicare pays for autism testing only if it is medically needed. Your doctor must show you need the test to help your health. Medical necessity means the test helps find out if you have autism or another health problem.

Your doctor must write down why you need the test. This helps Medicare decide if it will pay.

To show medical necessity, you need:

• A referral from a licensed healthcare provider.
• A full checkup, like cognitive or behavior tests.
• Speech or language tests if needed.
• Your medical history and a physical exam.
• Standard diagnostic tools like ADOS-2 or CARS-2.

Your doctor must show the test is not just for convenience. The test must follow medical rules. Sometimes, you need more paperwork or referrals, depending on your state and plan.

If you want Medicare to pay for autism testing, ask your doctor to explain how the test helps your health. Ask what papers you need before you set up your test.

Costs and Out-of-Pocket Expenses

What You Pay

If you get autism testing with Medicare, you pay some costs yourself. You must pay a monthly fee for Medicare Part B. In 2025, most people pay about $174.70 each month for Part B.

You also pay a yearly fee before Medicare helps. This yearly fee is called a deductible. For 2025, the Part B deductible is $240.

After you pay the deductible, Medicare pays 80% of the cost. You pay the other 20%. This is called coinsurance. If your test costs $1,000, you pay $200. Medicare pays $800. Some doctors may charge more than Medicare allows. You might pay extra if your doctor does not take Medicare assignment.

Medicare Advantage plans can have different costs. Some plans have lower copays or give extra benefits. Always check your plan’s rules before you get tested.

Costs can change based on your plan, your doctor, and where you live.

Reducing Costs

You can lower your costs in a few ways. If you have both Medicare and Medicaid, you may pay less. Medicaid can help pay for things Medicare does not cover.

This includes copays or deductibles. This is called wrap-around coverage. Many adults with disabilities, including autism, use both programs to save money.

Medicaid also gives home and community services in some states. These services can be case management, personal care, or respite care. Most Medicaid autism services are for people under 21. But adults with disabilities may get help through waivers or special programs. Sometimes, you may have to wait or meet extra rules.

If you have a supplemental insurance plan, it may help pay for costs Medicare does not cover. These plans are called Medigap policies.

They can help with deductibles, coinsurance, and copays. Not every plan covers the same things, so check your policy for details.

Ask your doctor if they take Medicare and Medicaid. This can help you avoid surprise bills.

How to Access Testing

Finding a Provider

You might want to know how to get autism testing with Medicare. Start by talking to your main doctor and ask for a referral. Many adults use state and national resources to find help.

Some states, like Utah and Idaho, have lists of centers that do autism testing and take Medicare. Groups like Autism Speaks have guides to help you find places for autism assessments.

You can look at community directories, like the one from NeuroClastic. This list shows doctors in states such as Ohio, Oregon, and Pennsylvania. For example, Amelia Galier Slama works in Ohio, and Dr. Brittany Lyman is in Pennsylvania.

These lists help you find people who might take Medicare. Always call the provider first to make sure they accept Medicare before you set up a visit.

Call the office and ask if they take Medicare and if they test adults for autism.

Many adults have trouble finding a provider. You might see long wait times or not enough trained doctors. Some providers may not know about sensory needs or how you talk.

Try to find clinics that say they offer autism-friendly services. If you worry about money, ask if they have sliding scale payments.

Verifying Coverage

After you find a provider, check if your Medicare plan pays for the test. Call your Medicare plan or look at their website. Ask if the provider is in-network and if the test is medically needed. You might need a referral or special approval.

Get your papers ready before your visit. Most plans want:

• A referral from your doctor
• Your medical history
• Results from old tests, if you have them
• Forms filled out by your doctor for your insurance

If you have guardianship or disability, bring proof. Some plans need more papers, especially if you are on a parent’s insurance after age 26. Tell your insurance company early so you do not have delays.

If you feel confused by forms or insurance rules, ask the provider’s office for help. Many offices have staff who can help you with the steps.

If you still wonder, does Medicare cover autism testing for adults, remember it depends on your plan, your provider, and having the right papers. Doing these things helps you get the care you need.

Medicare in 2025 does not pay just for adult autism testing. It helps with other health problems you might have. Medicaid might give more help for autism, but this depends on your state.

• Make sure you can get Medicare and ask your doctor for a referral.
• Call your Medicare plan to check if they will pay before you get tested.
• After you finish your test, join support groups, look at your results, and think about therapy or help at work.
  

  If you need more help, go to the Medicare website or talk to your plan. You do not have to do this alone.

FAQ

Does Medicare require a referral for autism testing?

Most of the time, you need a referral from your doctor. Medicare wants to see that the test is needed for your health. Always ask your doctor to write a referral before you plan any autism test.

Can you get autism testing more than once with Medicare?

You can get tested again if your doctor thinks it is needed. Medicare pays for more tests if your health or symptoms change. Your doctor must say why you need another test.

Will Medicare pay for online or telehealth autism assessments?

Medicare might pay for some mental health visits online. Not every autism test can be done this way. Ask your provider if they do telehealth and if Medicare will pay for it.

What if your provider does not accept Medicare?

You may have to pay the whole cost if your provider does not take Medicare. Always call the office before you go. Ask if they take Medicare and if they will bill your plan.