Understanding the Cost of Care: Covering the Cost of ABA Therapy

Applied Behavior Analysis (ABA) therapy is an evidence-based therapy option that has been scientifically shown to help children on the Autism Spectrum reach developmental milestones and catch up to their peers in key areas like communication, social skills, and fine and gross motor skills.

When a child receives an Autism diagnosis, many clinicians will recommend ABA therapy as part of a child’s care plan, which may also include services like Speech-Language Pathology (SLP) or Occupational Therapy (OT). And, while the benefits of these services are clear, the cost isn’t always so black and white.

An ABA therapy session costs, on average, around $150/ hour. That means, without insurance, a family needing full-time, intensive therapy services (35-40 hrs/wk) can expect to pay upwards of $5,000 per week. That’s nearly $275,000 per year, not including other medically necessary treatments.

That leaves us with a very important question – how do families cover the cost of care?

The best place to start is with your insurance provider. Nearly all carriers will cover at least some of the cost of therapy. However, it’s important to keep in mind that insurance coverage varies depending on the state, the insurance carrier, and the plan. Certain plans, for example, those offered through a trade union, may provide limited reimbursement or only grant coverage through a special request/approval process.

A major factor in the likelihood that services will be covered through insurance, hangs on having an official Autism diagnosis from a qualified provider (psychiatrist, developmental pediatrician, etc.). Always contact your insurance carrier and request a benefits investigation before starting services, to avoid unexpected medical bills and to understand what out-of-pocket costs you will be responsible for.

Why is ABA so expensive?

Like other healthcare facilities, the costs associated with ABA services are dependent on many factors, including:

  • The level of Autism diagnosis (which helps determine how much support a child may need)
  • The number of treatment hours recommended within a child’s individualized treatment plan (ITP)
  • The type of services recommended (i.e. focused therapy which typically takes place at home or in the community vs. intensive therapy which is most often provided in a specialized Autism center)
  • Insurance reimbursement rates which will vary depending on the state and provider
  • The clinician providing services. For example, a Board-Certified Behavior Analyst operating a private practice may have different hourly rates than a clinician employed by a medical group.

So how do parents pay for ABA?
In most cases, expenses can be significantly reduced by utilizing insurance coverage. Based on the benefits provided by the carrier, families may only have to pay coinsurance or copays out-of-pocket. Most state governments also offer grants or additional insurance options to help families make care more affordable. Several national, state, and local organizations, like the Doug Floutie Jr. Foundation for Autism or the Autism Society, can also help families by awarding grants and connecting them to additional resources.

Learn more:

Insurance Coverage with Midwest Autism & Therapy Centers

Grants & Funding for Autism Services

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