Is ABA Therapy Covered by Insurance in the United States

Last Updated on July 3, 2025 by John Hookway

You might ask, Is ABA Therapy Covered by Insurance?

In the United States, most insurance plans pay for ABA therapy. This is because federal and state laws say they must.

But you often need an official autism diagnosis first. The rules and limits can be very different in each state. For example, 31 states have special rules for autism coverage.

The amount of money covered and who can get it can change by state. Always check your insurance policy and state laws to see what your plan covers.

Key Takeaways

• Most insurance plans in the U.S. pay for ABA therapy for autism. But the rules are different in each state and for each plan. You usually need a real autism diagnosis and a treatment plan. This is needed for insurance to pay for ABA therapy. Fully insured plans must follow state laws. Self-funded plans might not pay for ABA therapy. Check your insurance policy for limits on hours, age, and costs. Do this before you start therapy. If your claim is denied, you can appeal. Give the right papers and follow your insurance company’s steps.

Is ABA Therapy Covered by Insurance?

Federal and State Mandates

If you want to know, Is ABA Therapy Covered by Insurance, you need to look at both federal and state rules.

Federal laws, like the 50-State Coverage Mandate, make every state require insurance to pay for ABA therapy for people with autism.

Medicaid rules also say states must give ABA therapy if a doctor says it is needed. These laws have helped many families get ABA therapy.

State laws add more rules.

All 50 states have laws that make insurance companies pay for ABA therapy, but the details are not the same everywhere. Some states have age limits, yearly spending caps, or session limits. Other states give more coverage and do not have these limits.

For example, Colorado and Massachusetts do not have age or spending limits for ABA therapy. But in Mississippi, coverage stops at age 8. South Dakota has different spending caps for different ages.

Tip: State rules have made it so there are 16% more Board Certified Behavior Analysts (BCBAs) to give ABA therapy. This means you have a better chance of finding a provider if your state has strong insurance laws.

Here is a table that shows how coverage is different in each state:

Plan Types and Exemptions

Is ABA Therapy Covered by Insurance?

The answer depends on your health plan. Most fully insured plans must follow state rules. This means they have to pay for ABA therapy if your state says so. But self-funded plans, which many big employers use, are different.

These plans follow federal law (ERISA) and do not have to follow state rules. About 65% of employer health plans are self-funded. Many of these plans do not pay for ABA therapy, but some do.

Here is a quick look at how different insurance plans cover ABA therapy:

Most insurance plans want you to have an official autism diagnosis from a qualified professional before they pay for ABA therapy.

You might also need a letter from your doctor saying ABA therapy is needed. Insurance companies often ask for reports and treatment plans from your ABA therapy provider to keep paying for it.

Key requirements for ABA therapy coverage:

1. A written autism diagnosis from a qualified professional.
2. Proof that ABA therapy is needed for medical reasons.
3. Ongoing treatment plans and progress reports from your provider.

If you have a self-funded plan, ask your employer or insurance company if ABA therapy is covered. If you have Medicaid, coverage depends on your state’s rules and if your child is eligible.

Is ABA Therapy Covered by Insurance? For many families, the answer is yes, but the details depend on your plan and where you live. Always check your policy and talk to your insurance company to know what is covered.

Types of Insurance Plans

Employer-Sponsored Plans

You might get health insurance from your job. These are called employer-sponsored plans. Many states now make these plans pay for ABA therapy for kids with autism.

Laws and advocacy groups have helped make coverage better. But what is covered can change by state and by employer.

• States have made laws so insurance must pay for ABA therapy as an important health benefit.
• Advocacy groups work to get more coverage and teach lawmakers about autism.
• Insurance companies use provider networks and telehealth to help families get ABA therapy.
• You may need to get approval before you start therapy.
• You might have to pay copays and deductibles, which can add up.

Most employer-sponsored plans want you to have an autism diagnosis. They may also ask for paperwork from your doctor.

Some plans limit how many hours of therapy you can get each year. Always check your plan to see what it covers.

Medicaid and CHIP

Medicaid and the Children’s Health Insurance Program (CHIP) help families who have lower incomes. These programs often pay for ABA therapy, but the rules are different in each state.

Some states have added more ABA therapy coverage in the last few years. Medicaid might pay for more hours or have fewer age limits than private insurance.

If your child is under three, early intervention programs might give ABA therapy through Medicaid. You should call your state Medicaid office to learn about your choices.

Note: Medicaid coverage for ABA therapy depends on your state’s rules and if your child can get it.

Marketplace Plans

Marketplace plans come from the Health Insurance Marketplace. These plans must follow federal and state laws about autism coverage.

Most marketplace plans pay for ABA therapy if you have an autism diagnosis. The amount of coverage and any limits depend on your state. You may need to use in-network providers and get approval first.

Is ABA Therapy Covered by Insurance? For marketplace plans, the answer is usually yes, but you should always read your policy and ask questions.

How Coverage Works

Requirements for Approval

To get insurance to pay for ABA therapy, you must follow some steps. Most insurance companies want a formal autism diagnosis from a qualified professional.

You also need to show that ABA therapy is needed for health reasons. Your doctor or therapist must write a plan that explains how ABA therapy will help with daily life skills.

Insurance companies often want you to get approval before starting therapy. This step checks if the therapy is needed and if your plan will pay for it.

Here are the usual steps you need to take:

1. Look at your insurance policy to see if ABA therapy is covered and if you need approval first.
2. Send in your autism diagnosis and a treatment plan with details.
3. Wait for approval for the first therapy sessions.
4. Keep sending updates and progress reports to keep getting coverage.

Tip: Always save copies of your paperwork and talk to your insurance company often. This can help you avoid delays or denials.

Coverage Limits and Costs

Insurance plans set rules on how much ABA therapy they will pay for. These rules can include how many hours each week, yearly spending limits, or age limits.

Some plans pay for up to 20 hours a week, but others have a yearly cap. You might also have to pay a deductible or co-pay for each session.

ABA therapy usually costs $120 to $150 per hour, but insurance can lower your cost to about $50 per session.

You should always check your policy or call your provider to know your coverage and costs.

Common Reasons for Denial

Sometimes, insurance companies say no to paying for ABA therapy. This can happen if you forget paperwork, use the wrong codes, or do not get approval first.

Some plans do not cover ABA therapy at all. If you get denied, check if you missed any papers or if your provider used the right codes.

Ask your insurance company why you were denied and how to fix it.

If you wonder, Is ABA Therapy Covered by Insurance?, remember you must meet all the rules and follow your plan to get approval.

State Differences

State Mandates

ABA therapy coverage is not the same in every state. All states must follow a federal rule. This rule says insurance must pay for ABA therapy for people with autism.

But each state can add its own rules. Some states have age limits or spending caps. Others let more people get coverage with fewer rules.

This means rules are different all over the country. You need to learn your state’s laws to know what your insurance will pay.

For example, Alabama, California, and Illinois make insurance cover ABA therapy. But they only do this for kids under a certain age.

Florida has yearly spending caps. This means there is a limit on how much insurance pays each year.

Idaho and Wyoming do not have a law that makes insurance cover ABA therapy. Families in these states may have a hard time getting coverage.

Tip: Always look at your state’s rules and your insurance policy. Some providers can help you check your insurance and explain your coverage.

Fully Insured vs. Self-Funded Plans

The kind of insurance plan you have also matters. Fully insured plans must follow state laws. This means you usually know what is covered for ABA therapy. You might pay less money out of your own pocket. The steps to get therapy approved are often easier.

Self-funded plans are different. These plans follow federal law, not state law. Your employer picks what is covered. Some self-funded plans pay for ABA therapy, but some do not.

You might have more limits, higher costs, or no coverage at all. Many families with self-funded plans have a harder time getting insurance to pay for ABA therapy.

• Fully insured plans: Must follow state rules, so coverage is more steady.
• Self-funded plans: More flexible, but your employer can change or limit coverage.
• You may pay more with self-funded plans.
• Advocacy groups can help you learn your rights and find ways to get coverage.

If you want to know if ABA Therapy is covered by insurance, you need to check your state’s rules and your plan type. This helps you know what to expect and how to plan for your child’s care.

Appeals and Maximizing Coverage

Steps to Appeal a Denial

If your insurance says no to ABA therapy, you can fight back. First, read the denial letter very carefully. The letter tells you why they said no.

Gather all your important papers, like your child’s diagnosis, treatment plan, progress notes, and billing codes.

Write a simple letter that explains why you think the denial is wrong. Add medical records and expert opinions to show why ABA therapy is needed.

Follow your insurance company’s rules for appeals step by step. Make sure you send your appeal before the deadline. If your first try (called an internal appeal) does not work, you can ask for an outside review.

This means someone who does not work for the insurance company will look at your case. If your child needs help fast, you can ask for a quicker review.

Here is a table that shows how often appeals work:

Tip: Always keep copies of everything you send. Write down every phone call with your insurance company.

Tips for Getting the Most Coverage

• Read your insurance policy so you know what is covered.
• Use in-network ABA providers to save money.
• Turn in claims and paperwork on time.
• Keep good records of all therapy sessions and calls.
• Work with your ABA provider to make sure your treatment plan fits insurance rules.
• Ask about help from Medicaid, work programs, or charities.
• Learn your state’s laws and use them if you need to.

Families who keep good records and follow the steps have a better chance of getting coverage.

Questions to Ask Your Insurer

• Does my plan pay for ABA therapy for autism?
• What papers do I need for approval?
• Are there limits on hours, age, or money each year?
• Do I need approval before starting therapy?
• Which ABA providers are in-network?
• What will I have to pay myself?
• How do I appeal if my claim is denied?
• How long does it take to finish an appeal?

Asking these questions helps you know your benefits and avoid surprises.

ABA therapy is covered by insurance in most states. Your coverage depends on your plan and state rules. Many families still have problems getting help.

There are not enough providers, and costs can be high. Only 15% of kids with insurance get most of their ABA hours. About 30% of kids with autism do not get any therapy.

To find out if ABA therapy is covered, check your policy. Gather your papers and ask for help if you need it. Stay active in the process. Remember, you are not alone.

FAQ

What documents do you need for ABA therapy insurance approval?

You must have an autism diagnosis from a qualified expert. You also need a treatment plan from your ABA provider. Some insurance companies want progress reports and a letter that says ABA therapy is needed.

Can you get ABA therapy without an autism diagnosis?

Most insurance plans want an official autism diagnosis before they pay. If you do not have this, your insurance will probably say no.

Does insurance cover ABA therapy for adults?

Some states and plans pay for ABA therapy for adults. But many only pay for children. You should check your policy or call your insurance company to see if adults are covered.

What should you do if your insurance denies ABA therapy?

• Read the denial letter very carefully.
• Collect all the papers you need.
• Send an appeal to your insurance company.
• Ask your ABA provider to help with the paperwork.

Stay organized and keep copies of everything you send in.