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Where to Start

Before looking into the options for health insurance listed below, it is important to evaluate the position you are in now. Questions like “What kind of insurance do I have?” and “What do I want out of a plan?” are essential. The first step is to contact your current health insurance provider. Ask them about the types of coverage that they provide. Also, ask them about the cost (this includes out-of-pocket costs, deductibles, and premiums). Another important question to ask is if they provide mental health coverage. Many companies list autism coverage under mental health treatment. After assessing your current provider or a provider that you would like to gain coverage from, the next step is to learn more about our program. Since the pandemic began, parents are being forced to receive telehealth services for their children. Children with autism need ABA home care to help better their instruction time. Established in 2015, Achievement Behavior Services is owned by a Board Certified Behavior Analyst who specializes in reaping the benefits of in-home ABA therapy. ABA therapy is backed with over 40 years of research. With in-person services, ABA therapy begins by assessing a child’s primary needs. After the initial consultation, we determine the eligibility of your insurance. This is where the list of insurance companies come in at the bottom of this article. With this guide, you will be able to better determine whether or not your insurance will help cover our services. After both of the initial assessment and insurance took care of, the next step in our service is to assess the child’s current skill level in detail. The assessment is usually done in the home to help the child grow accustomed to the way therapy will be implemented. After this final assessment, we will customize a treatment plan that will keep your child’s strengths and weaknesses in mind. That way, we can look forward and make consistent progress. Looking for an insurance company that will cover your ABA services can be difficult. But with this guide, you will find one in no time.

New York and New Jersey State Laws

In the United States, all 50 states require insurance plans to cover ABA. However, this only includes fully-insured plans. Self-funded plans are regulated by the federal government. Some health insurance companies cover ABA no matter if they are self-funded or state-regulated. In the state of New York, fully insured plans are required to carry coverage for people on the autism spectrum. This state law applies not only to individual plans but also to fully-insured large and small group plans. Since autism was added to the list of requirements for health insurance in November 2012, the state of New York does not cap ABA coverage. Services covered by the law include diagnosis, behavioral health care (such as ABA), and psychological/psychiatric care. In New Jersey, fully insured plans by the state are also required to cover autism. The law applies not only to individual plans but also to fully-insured large and small group plans. Since autism was added to the list of requirements for health insurance in February 2010, coverage for ABA was granted to people with autism under the age of 21. Services covered by the law include ABA, speech therapy, occupational therapy, and physical therapy. The law in New Jersey is not as comprehensive as the law in New York; however, it still requires coverage for children on the autism spectrum. If covered by a fully-insured plan, you should have no trouble getting ABA coverage. If you have a self-funded plan through your employer, there are still ways to advocate for ABA coverage.

The Marketplace

During these troubling times, many people have lost the health insurance provided to them through their job. The Health Insurance Marketplace is a great resource to help find affordable private healthcare plans. The Marketplace not only is a search hub for plans but also can tell you whether you are eligible for financial assistance under your state. In the state of New York and New Jersey, the Marketplace is required to include ABA services as a part of the “Essential Health Benefits” package. The Marketplace offers child-only and family insurance plans. If you would like to keep your insurance through your employer, you can purchase a plan for your child to cover their ABA services. A child-only plan is a good option if your child lives with grandparents covered by Medicare. Also, if parents of the child are divorced or live in different states. The Marketplace allows parents to cover their children with financial assistance. If your health insurance plan is purchased outside of the Marketplace, it may be harder to receive lower-cost premiums or less out-of-pocket expenses. Since many people are out of work, the Marketplace may be the best option for coverage for families, especially with children on the autism spectrum. Although the Marketplace is a great option for families today, once the employment market becomes stable many will look to their jobs for health insurance. Below this section are two health insurance companies that guarantee coverage for ABA services.

United Healthcare

United Healthcare is the first insurer to offer ABA services nationwide. The insurer will offer ABA coverage in every small and large group plan that they offer. As ABA services grew to become a necessity, this insurer group wanted to meet the growing demand. In January 2017, the company put this statement into effect and implemented autism therapy coverage even in states that do not require ABA coverage. As for self-funded plans through employers, United Healthcare adds ABA benefits to all companies they are affiliated with unless the company chooses to opt-out. Although companies do not have to always follow United Healthcare’s recommendation to offer ABA benefits, most will comply with them. Despite this change, individual policies are not included. They will not offer ABA coverage as a standard benefit. This differs from the Marketplace that allows parents to get child-only plans. However, it is a step in the right direction by covering autism families.