Does Insurance Cover ABA Therapy? | Autism Insurance Guide

Does Insurance Cover ABA Therapy for Autism?

If you’re researching ABA therapy for your child, one of the first questions that probably comes to mind is: “Will my insurance actually cover this?” It’s a fair question. ABA therapy can involve many hours each week, and the thought of navigating insurance approval on top of everything else can feel overwhelming.

Here’s what you need to know up front: most insurance plans do cover ABA therapy, especially when your child has a formal autism diagnosis.

But the specifics—how much is covered, what your out-of-pocket costs will be, and what steps you need to take—depend on your individual plan and where you live. Understanding how insurance works for autism services can help you move forward without the guesswork.

Reach Out Today

Understanding ABA Therapy and Insurance Coverage

ABA therapy (short for Applied Behavior Analysis) teaches children with autism the skills they need to communicate, work through challenging behaviors, and handle everyday tasks more independently. It’s one of the most researched and effective treatments for autism.

Most insurance plans recognize ABA as a medically necessary treatment for autism spectrum disorder, which means autism ABA therapy insurance coverage is available under many plans. But “available” doesn’t always mean automatic. Insurance companies typically require a formal autism diagnosis and documentation showing why therapy would help your child.

Once you have those pieces, coverage usually follows. But the details—how much you’ll pay, how many hours are approved, what steps you need to take first—depend entirely on your specific plan.

What Insurance Companies Require for ABA Coverage

Before your insurance will cover ABA therapy, you’ll usually need to meet certain requirements. Here’s what most plans ask for:

A formal autism diagnosis

Your child needs an official diagnosis of autism spectrum disorder from a qualified provider, usually a developmental pediatrician, psychologist, or psychiatrist.

A treatment plan from a BCBA

A Board Certified Behavior Analyst will assess your child and create a detailed treatment plan. This plan outlines your child’s current skills, target goals, and how many hours of therapy per week are recommended.

Prior authorization

Most insurance plans require you to get approval before therapy starts. Your ABA provider typically handles this step, submitting the treatment plan and medical records to your insurance company for review. Approval can take a few weeks, so it’s worth starting this process early.

In-network providers

Insurance plans usually have a network of approved providers. If your ABA provider is in-network, your costs will be lower. Out-of-network care is sometimes covered, but often at a reduced rate or with higher out-of-pocket expenses.

Financial responsibility

Even with insurance coverage, you may have costs like a deductible (the amount you pay before insurance kicks in), copays (a set fee per session), or coinsurance (a percentage of the total cost). These vary widely depending on your specific plan.

Autism Insurance Mandates by State

Here’s some good news: every state in the U.S. now has a law requiring insurance plans to cover autism services, including ABA therapy. These laws, often called autism insurance mandates, were the result of years of advocacy by families and autism organizations.

But while every state has a mandate, the details look different depending on where you live. Some states have generous coverage with few restrictions. Others impose limits on age, the number of therapy hours per year, or annual spending caps.

For example, some state mandates include:

Age limits – Coverage might end when a child turns 18, or in some states, 21

Annual or lifetime caps – A maximum dollar amount the plan will cover per year or over a lifetime

Hour limits – Restrictions on how many hours of therapy per week or year are covered

Plan type – Some mandates only apply to fully insured plans, not self-funded employer plans

Medicaid also covers ABA therapy in all states, as it’s considered a medically necessary treatment for children with autism. Coverage details for Medicaid can differ by state, but if your child qualifies, therapy should be covered.

Autism Insurance Mandate in Colorado

Colorado’s autism insurance mandate requires most private insurance plans to cover the diagnosis and treatment of autism, including ABA therapy. The law applies to children and young adults up to age 21. There’s no annual dollar cap or lifetime limit on ABA therapy coverage, which means families have access to the hours their child needs based on medical necessity. However, the specifics of your coverage—including any copays, deductibles, or prior authorization requirements—will depend on your individual plan.

Autism Insurance Mandate in New York

New York requires insurance plans to cover ABA therapy for individuals with autism, with no age limit for coverage. This is one of the more comprehensive state mandates. The law doesn’t impose annual or lifetime caps on ABA therapy, so coverage is based on what’s medically necessary rather than arbitrary limits. As with other states, you’ll still need prior authorization and a formal autism diagnosis, and your plan’s deductible and copay structure will apply.

Autism Insurance Mandate in New Jersey

New Jersey’s mandate requires coverage for ABA therapy and other autism treatments for individuals up to age 21. The state doesn’t impose a dollar cap on ABA services, but your insurance plan may have limits based on medical necessity. Coverage includes diagnostic evaluations and ongoing therapy, and most plans cover a significant number of therapy hours per week when recommended by a BCBA. Like other states, prior authorization is typically required before starting services.

Does Insurance Cover Autism Testing?

Whether insurance covers autism testing depends on your plan and your child’s age, but in most cases, yes—diagnostic evaluations are covered.

For children, most private insurance plans cover autism evaluations when there’s a medical reason for the assessment. This usually means your pediatrician has noted developmental concerns or you’ve completed a screening that suggests further evaluation is needed. Medicaid also covers autism diagnostic evaluations for children.

For adults, coverage gets a bit more complicated. Some insurance plans cover autism testing for adults, especially if there’s a clinical reason (like ongoing difficulties with social communication or employment challenges). But not all plans include this, and you may need to check specifically with your insurer. Medicaid coverage for adult autism testing varies by state.

If you’re unsure whether testing is covered, call your insurance company and ask about coverage for “autism diagnostic evaluation” or use the diagnostic codes your provider gives you. Getting clarity upfront can help you avoid surprise bills.

How to Check Your ABA Therapy Coverage

If you want to know exactly what your insurance plan covers, here’s how to find out:

Call your insurance company
Check the back of your insurance card for the customer service number. When you call, mention that you’re asking about coverage for ABA therapy or “outpatient behavioral health services” for a child with autism. Be ready to provide your child’s diagnosis and ask specific questions.

Questions you may want to ask:

Does my plan cover ABA therapy for autism spectrum disorder?

Is prior authorization required before starting therapy?

Do I need to use in-network providers, or is out-of-network care covered?

What are my deductible, copay, and coinsurance amounts for ABA therapy?

Are there limits on the number of therapy hours per week or year?

Does coverage have an age limit?

Review your Summary of Benefits and Coverage (SBC)
Your insurance plan should provide a document that outlines what’s covered. Look for sections on behavioral health, autism services, or outpatient therapy.

Request a Quote of Benefits (QOB)
A Quote of Benefits gives you a detailed breakdown of what your plan will cover for ABA therapy, including estimated costs. You can request this directly from your insurance company, or your ABA provider can request it on your behalf as part of verifying your benefits.

Ask your ABA provider for help
Most ABA providers, including United Care ABA, have billing teams that verify insurance benefits as part of the intake process. They can walk you through what your plan covers, what you’ll pay out of pocket, and how the prior authorization process works.