Does My Insurance Cover ABA Therapy?

All insurance plans sold through the Marketplace or “exchange” must comply with certain federal guidelines, known as the Affordable Care Act (ACA) – also referred to as health reform or “OBAMACARE.” These guidelines include a list of 10 “essential health benefits.”

As of January 1, 2014, ABA therapy was considered an “essential health benefit” and required to be covered by any insurance sold in the Marketplace in Ohio for up to 20 hours per week based on medical necessity.

Yes. Although you will not be eligible for a discounted Marketplace plan if your child has access to an employer-sponsored plan, you can still purchase a non-discounted child only Marketplace plan that covers ABA therapy.

Some plans allow you to carry more than one policy for your child while others do not. It’s best to speak with your plan administrator human resources if you are considering dual coverage for your child.

Marketplace plans are available for purchase only during open enrollment periods. The enrollment period for 2018 ended on December 15, 2017. 

However, you may be able to purchase a Marketplace plan outside the open enrollment period if you qualify for a Special Enrollment Period (e.g., getting married, having a child, moving to a different state). See if you can still get 2018 health coverage.

Yes. Even though you acquired health insurance before the Affordable Care Act, your child should still be eligible to receive 20 hours of ABA therapy per week based on medical necessity.

Unfortunately, self-insured plans are not required to cover ABA therapy. However, more and more companies have begun to voluntarily include ABA coverage for their employees. It’s best to speak with your plan administrator human resources if you are considering dual coverage for your child.