Four Game Changing Facts About Obamacare and ABA Therapy Coverage Every Parent Must Know

It’s here.

Open enrollment.

And if your child is diagnosed with autism and needs ABA therapy, here are four vital facts you must know about Obamacare and ABA therapy:

  1. Insurance Plans Sold in Ohio Must Include ABA Therapy Coverage.
    Ohio is one of only 29 states where ABA therapy is a required benefit on any insurance plan in accordance with the Affordable Care Act (ACA).

According to the ACA, insurance plans must include 10 categories of “essential health benefits.” One of these ten essential health benefits is rehabilitative and habilitative services, described as “those that help patients acquire, maintain, or improve skills necessary for daily functioning.”

Each state was then left to determine what benefits to include under habilitative services. They had their choice to include ABA therapy. Or not.

If you live in Ohio, count your lucky stars.

According to a state mandate by Governor of Ohio, John H. Kasich, Applied Behavior Analysis (ABA) must be included as a benefit under habilitative services. ABA therapy coverage is available to children (0 to 21) with a medical diagnosis of Autism Spectrum disorder. The benefit covers 20 hours of therapy per week.

Here is the list of 29 states that have not only passed mandates requiring private insurers to offer ABA therapy in state regulated plans, but also have mandated the benefit in Affordable Care Act plans:

New Hampshire
New Jersey
New Mexico
New York
West Virginia


  1. Your Child Cannot be Denied Coverage Because of a Pre-Existing Condition. 

Having a pre-existing condition (like autism) used to be dead-end when looking for an insurance plan with ABA therapy coverage.

Insurance companies had the power (and wielded it often) to deny coverage to your child because of their pre-existing condition of autism.

Not anymore.

Pre-existing conditions are now non-existent.

Obamacare eliminated pre-existing conditions back in 2014 with the ACA. Now, you’re child with autism can’t be denied coverage, charged more, or denied treatment because of their health status.


  1. Your Child Does not Have to be a Dependent on Your Policy. You Can Purchase a Child Only Policy That Includes ABA Therapy.Many people believe their only option to insure their child is to include them as a dependent on their insurance plan.

That’s false.

You can purchase a separate policy for your child, called a “child only policy.”

A child only policy gives you the freedom to choose a plan that includes ABA therapy. Plus, the premium is oftentimes less for a child-only policy.

So if your current insurance plan doesn’t cover ABA therapy for your child, don’t worry. There are plenty of child only policies that will. Give us a call. We’ll tell you all about them.

  1. You’re Child Only Policy is a Bona Fide Insurance Plan that Includes ABA Therapy Coverage.

“Am I purchasing a policy that only covers ABA therapy and nothing else?”

We hear this question a lot. The answer is, “no.”

You’re purchasing a normal, comprehensive insurance policy. That has ABA therapy as one of its benefits.

Many people we speak to are nervous to purchase a child only insurance plan because they think it offers less coverage or is inferior.

That’s a mistake.

A child only plan is a real, regular insurance plan. It has much of the same coverage of your current plan. Plus, it has the added benefit of ABA coverage.

Time is Running Out

On January 31, 2016 open enrollment ends.

Now is the time to find out if your current insurance plan covers ABA coverage.

Now is the time to decide if a child only policy is right for you.

Now is the time to contact us.

We can help you make the best decision and get the most ABA therapy coverage in 2016.