Insurance Support

• DC – there is not a law that requires DC employees to have ABA coverage in their plans, but some plans do cover it.  Please check with your plan for details.
• Florida –state employees have coverage for ABA in their health plan by law.
• Maryland – state employees have coverage for ABA under the Maryland mandate.
• Virginia – state employees have coverage for ABA in their health plan by law

In some states, individual plans are required to cover ABA by law. Those plans can be purchased directly from the insurance company, or through your state’s health exchange. If you have employer-based insurance that does not cover ABA, it is possible to purchase a child-only plan that does covers it.

• DC:  Individual plans cover ABA.
• Florida: While it is not mandated by law for individual policies to cover ABA, select individual plans sold in Florida include coverage for ABA.  Contact us for more information.
• Maryland: Individual plans cover ABA.
• Virginia: Starting in January 2021, individual plans cover ABA.

The best thing to do to determine if you have coverage for ABA therapy for the treatment of an ASD is to call your insurance company and ask, but here are some tips to make sure you are getting the right information.

• The first step is to determine if your group health plan is fully-funded or self-funded (aka self-insured). You can ask either your insurance company or your HR department.
• For self-funded plans: Ask your HR department or insurance company whether the policy contains an autism benefit. (There is a partial list of self-funded companies with autism benefits listed on the Autism Speaks website.
  • If the plan does not cover it, consider using the Autism Speaks Self-Funded Employer Tool Kit to approach your employer about adding an autism benefit.
• For fully-funded plan: Determine whether your policy is subject to a state autism insurance mandate.
  • Ask your HR department or insurance company for the state in which the insurance contract was written and whether it is a small (50 employees or less) or large (more than 50 employees) group policy. Note: the relevant state is where the contract was written, NOT where you live.
  • Then visit Autism Speaks to determine if the autism insurance mandate in that state applies to a plan of your type. If your type of plan is covered under the law, your insurance policy must cover the mandated level of benefits.
• For fully-funded employer sponsored plans in our area:
  • DC: Coverage is mandated by the Affordable Care Act in small group plans.
  • FL: Florida law requires coverage in large group plans only.
  • MD: Coverage for ABA is required for all children under the age of 19 in all plans.
  • VA: Coverage for ABA is required in all plans.

If your plan does cover ABA, you will most likely require pre- authorization for services. Contact us for help.

Note: unless you are speaking to a specific “ABA” department at your insurance company, please be skeptical of the information you are given unless you follow the instructions above. When coverage is not mandated by law, many plans, unfortunately, exclude coverage for ABA therapy.

No insurance coverage for ABA?

We know that intensive ABA services are expensive. But we also know that it is an investment in your child’s future. If you can afford to pay for them directly, please consider doing so. You may be able to purchase a policy for your child through the individual market / health exchange.

• Early intensive behavioral services change the trajectory of your child’s development
• Providing therapy to a child at a young age can significantly decrease the lifetime costs of caring for him/her. In fact, according to the Autism Society of America, “The cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention.”