There are many methods of therapy available for people with autism. Among them is Applied Behavioral Analysis (ABA), which uses positive reinforcement to help the student learn tasks and redirect undesired behaviors. ABA Therapy is most effective when implemented beginning at age 2 or 3.ABA therapy, along with other therapies, can be quite costly, so having insurance that covers this therapy is crucial. Although the amount of states requiring state-regulated insurance plans to cover this has increased over the years, there are still some states that do not have this law. In addition, these laws only extend to new health insurance Marketplaces if the state requires the companies to abide.
The Affordable Care Act requires state Marketplaces’ insurance plans to cover 10 essential benefits, including “behavioral health treatment” and “rehabilitative and habilitative services and devices,” but the Department of Health and Human Services does not define treatment for autism as an essential health benefit. Therefore, it is up to the states’ discretion.[i]
The following are the state Marketplaces that will cover ABA therapy through insurance: Arizona, Arkansas, California, Connecticut, Delaware, Indiana, Illinois, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Missouri, Montana, Nevada, New Jersey, New Hampshire, new York, Ohio, Texas, Vermont, West Virginia, Wisconsin, and Washington D.C. Colorado has coverage, but the insurer can limit the number of visits and Minnesota’s coverage will go into effect in 2016. It is important to note, however, that the out-of-pocket cost can still be high, and too high for some families. Beginning in 2015, families may have to pay the out-of-pocket cap of $12,700 for autism treatment.
[i] “Web MD” Autism coverage varies from state to state. 13 Aug 2013. Web. < http://www.webmd.com/health-insurance/20130722/autism-healthcare-reform>