Open Enrollment and ABA Therapy: A Guide for Families Exploring Coverage Options

Open Enrollment and ABA Therapy: A Guide for Families Exploring Coverage Options

Understanding Open Enrollment

For families navigating autism services, open enrollment can be an important opportunity. This annual period allows you to review your health insurance, switch plans, or make updates that can directly impact your child’s access to ABA therapy. If your current plan does not cover ABA or includes limited access, this period can be a critical time to explore options that better support your child’s needs.

Open enrollment typically occurs in the fall, with the federal marketplace opening November 1^st, though dates may vary based on your employer or marketplace. Making thoughtful changes now can unlock services that may not have been accessible under your previous plan.

“Open enrollment is more than just paperwork — it’s a powerful opportunity for families to access life-changing services like ABA therapy that may have been out of reach under their current plan. Taking the time to review your options now can open doors to care and support your child truly deserves.” Catherine Raley, Director of Patient Journey at Little Leaves Behavioral Services.

Why Insurance Coverage Matters for ABA Therapy

ABA therapy (Applied Behavior Analysis) is a widely recommended, evidence-based treatment for children with autism. It helps build core skills like communication, social interaction, self-care, and behavior regulation.

While many commercial plans cover ABA, coverage still varies widely, depending on your state, plan type (fully insured vs self-funded), age limits, caps, authorization process, provider network, and more. Some plans have restrictive provider networks, unclear benefit language, or coverage limits that prevent access to consistent care. This is where open enrollment can make a difference. Reviewing your plan now may allow you to:

• Choose a policy with better coverage
• Enroll in a plan that includes Little Leaves as an in-network provider
• Select coverage that supports the right level of care for your child, including higher-intensity therapy or broader support

 “ABA therapy helps children with autism gain the foundation they need to connect with others and grow more independent. When families can access consistent, high-quality care, it opens the door to meaningful progress in everyday life and brings families together in ways they never thought possible.” Barbara Davis, Vice President of Operations.

What to Consider When Evaluating Plans

If you’re asking how to find an ABA provider or want to confirm eligibility, here are a few questions to guide your review:

• Does this plan include ABA therapy as a covered benefit for children diagnosed with autism?
• Is Little Leaves an in-network provider under this plan?
• What is the process for obtaining pre-authorization or referrals for ABA therapy?
• Are there limits on the number of hours or duration of ABA services covered each year?
• Are there any age limits for ABA covered (for example, services covered until age 12)?
• Does the plan restrict coverage based on where services are provided (school setting)?
• What are the annual out of pocket costs, including copays, coinsurance, and deductibles, for this plan ?
• Is there a lifetime or annual cap on ABA therapy?
• If changing plans, is there a continuity of care provision so therapy can continue without interruption?

Our Family Support Specialists can walk you through the process and help you understand what to ask your HR department, insurance broker, or healthcare marketplace representative.

We’re Here to Help

We know that navigating insurance and coverage decisions can be confusing—but you don’t have to do it alone. Whether you’re evaluating your current plan or preparing to make a change, Little Leaves is here to help you make informed decisions that support your family’s goals. Please reach out via our contact form or to call us at 866-553-2837 to speak with our Family Support Specialists who can assist you in navigating this process.

Little Leaves Behavioral Services provides high-quality, center-based ABA therapy for children ages 1 to 6 with autism. Our programs are individualized, evidence-based, and delivered in a supportive, preschool-like setting. With a 1:1 therapist-to-child ratio and a team of credentialed clinicians, we help children build meaningful skills in communication, social interaction, and independence. We proudly serve families in Maryland, Virginia, and Florida. We recently opened our doors in Middle River and Owings Mills, MD to support more communities in need.