ABA Therapy Insurance Coverage
In the states Alpaca Health serves, Medicaid, TRICARE, and most private plans cover ABA therapy for autism when it's medically necessary. Find your plan below to see what it covers and what to expect. Alpaca Health checks your benefits for free, handles the approval paperwork with your BCBA, and doesn't have a waitlist.
Check if Alpaca Health takes your plan
Choose your state and then your plan. You'll see right away whether Alpaca Health accepts it there.
Colorado
ABA therapy in Colorado →Cities: Denver· Colorado Springs· Fort Collins· Pueblo
State law: Fully insured plans must cover autism treatment for children, including ABA, and the law sets no dollar cap or specific age cutoff (C.R.S. 10-16-104).
Private and employer plans
Medicaid plans
Military and VA plans
Hawaii
ABA therapy in Hawaii →Cities: Honolulu· Aiea· Hilo· Kahului
State law: Fully insured plans must cover autism diagnosis and treatment for children under 14, and may cap ABA at $25,000 a year (HRS 432:1-614).
Private and employer plans
Medicaid plans
Military and VA plans
Also in Hawaii: Kaiser Permanente covers ABA once its own team confirms the diagnosis and refers your child. We check whether your plan lets your child see one of our BCBAs.
Michigan
ABA therapy in Michigan →Cities: Detroit· Ann Arbor· Bloomfield Hills· Brighton
State law: The state insurance regulator says insurers may not apply age limits or yearly dollar limits to autism benefits.
Private and employer plans
Military and VA plans
Nebraska
ABA therapy in Nebraska →State law: Fully insured plans must cover autism treatment for children under 21, and may limit ABA to 25 hours a week (Neb. Rev. Stat. 44-7,106).
Private and employer plans
Medicaid plans
Military and VA plans
Nevada
ABA therapy in Nevada →State law: Group plans must cover autism treatment for children under 18, or under 22 while in high school, and may cap ABA at the equivalent of $72,000 a year (NRS 689B.0335).
Private and employer plans
Medicaid plans
Military and VA plans
North Carolina
ABA therapy in North Carolina →Cities: Charlotte· Raleigh· Durham· Greensboro
State law: Fully insured plans must cover autism treatment, may cap ABA at $40,000 a year (adjusted yearly for inflation), and may limit ABA to children 18 and younger (N.C. Gen. Stat. 58-3-192).
Private and employer plans
Medicaid plans
Military and VA plans
Texas
ABA therapy in Texas →Cities: Austin· Dallas· Houston· San Antonio
State law: Fully insured plans must cover autism treatment when the diagnosis came before age 10, and may cap ABA at $36,000 a year from age 10 (Texas Insurance Code 1355.015).
Private and employer plans
Medicaid plans
Military and VA plans
Outside our states: Managed Health Services serves Indiana and Wisconsin, where Alpaca Health doesn't have BCBAs today.
How insurance covers ABA therapy
Plans pay for ABA when it's medically necessary. That usually means a licensed clinician has diagnosed autism and a BCBA's assessment shows your child needs therapy.
Autism diagnosis
From a licensed clinician
BCBA assessment
Shows what your child needs
Plan approval
Your plan approves the treatment plan first (prior authorization)
Therapy starts
At home or by telehealth
Diagnosis: Most plans need an autism diagnosis first. Health First Colorado is an exception: eligible children can get behavioral therapy without one.
Medicaid: Federal rules require every state's Medicaid to cover needed autism treatment for children under 21, a benefit called EPSDT (Early and Periodic Screening, Diagnostic and Treatment).
Military families: TRICARE covers ABA through its Autism Care Demonstration, with no age limit or yearly cap.
Is your plan fully insured or self-funded?
Employer plans come in two kinds, and the kind you have decides whether your state's autism law applies.
Fully insured
Self-funded
How to tell: Your HR team can tell you, or we check during your free benefits review. Medicaid, TRICARE and CHAMPVA follow their own program rules.
What ABA therapy costs with insurance
How much you pay depends on how your plan splits each bill. Your share stops growing at the out-of-pocket maximum.
Until the deductible
You pay for covered care yourself.
Copay or coinsurance
You pay a set fee or a share of each bill.
After the out-of-pocket maximum
Your plan pays 100% of covered in-network care.
Medicaid: Texas Medicaid, Health First Colorado and Med-QUEST say covered ABA costs families nothing, and NC Medicaid plans charge no copay.
TRICARE and CHAMPVA: TRICARE charges one copayment or cost share a day for ABA. CHAMPVA may ask you to share part of the cost.
Real numbers from our partner clinics, what families owed and how long approvals took, are on five plan pages: Aetna, Cigna, Blue Cross Blue Shield, Health First Colorado and TRICARE West.
If insurance doesn't cover everything
A no from your plan isn't the last step. When a plan says no or leaves a large bill, you still have options.
Appeal
Your plan has to tell you why it said no. You have the right to appeal, then to ask for an outside review.
Medicaid fair hearing
Medicaid members can ask for a state fair hearing when a service or a prior authorization is denied. In a Medicaid health plan, you appeal to the plan first.
Two plans
For a child on both parents' plans, the plan of the parent whose birthday comes first in the year usually pays first, under the standard coordination rule.
HSA or FSA
The IRS counts therapy received as medical treatment as a medical expense, so HSA or FSA money can usually pay your share.
How Alpaca Health handles your insurance
You don't have to call your insurance company yourself. Our team takes it from the first form to the first session.
- Tell us about your child: Fill out our short intake form with your child's details and your plan.
- We check your benefits: Our team confirms your coverage and follows up within one business day with what you may owe.
- Meet your BCBA: We match you with an independent BCBA near you who accepts your plan. Your BCBA assesses your child and writes the treatment plan.
- We handle the approval: We submit the paperwork your plan needs, and therapy starts at home or by telehealth once it's approved.
Does insurance cover ABA therapy?
In most cases, it does. Medicaid, TRICARE, and most private plans in the states Alpaca Health serves cover ABA for autism when it's medically necessary. Self-funded employer plans set their own rules, so we check your benefits for free before therapy starts.
How much does ABA therapy cost with insurance?
It depends on your plan. With private insurance, you pay your deductible and then a copay or coinsurance until you reach your out-of-pocket maximum. Medicaid programs in Texas, Colorado and Hawaii say covered ABA costs families nothing.
Do I need an autism diagnosis for insurance to cover ABA?
Most plans need a diagnosis from a licensed clinician before they approve ABA. Health First Colorado is an exception and covers behavioral therapy for eligible children without one. If your child hasn't been evaluated yet, start with how evaluations work.
Does insurance cover ABA for ADHD or other diagnoses?
Most private plans cover ABA for autism, because state autism insurance laws are written for autism. Health First Colorado, Colorado Medicaid, is broader. Eligible children can get behavioral therapy for other conditions, such as developmental delay, when it's medically necessary.
What is prior authorization for ABA therapy?
It's your plan's review of your child's treatment plan before therapy starts. Your BCBA sends the assessment, goals, and hours requested, and the plan approves hours for a set period. Asking for more hours when that period ends is called reauthorization, which is a new review of your child's progress. Alpaca Health handles this paperwork with your BCBA.
How many hours of ABA does insurance cover?
There's no single number. Your BCBA recommends weekly hours in the treatment plan, and your plan approves hours for a set period. Some state laws let plans set limits, such as Nebraska's 25 hours a week, while TRICARE has no yearly cap.
Does Medicaid cover ABA therapy?
Yes, for children and youth under 21 when it's medically necessary. Federal rules require every state's Medicaid program to cover needed autism treatment for members under 21. The programs in Texas, Colorado and Hawaii say covered ABA costs families nothing.
What if my insurance denies ABA therapy?
Ask the plan for its reason in writing, then file an internal appeal. If the plan still says no, you can usually ask for an outside review, and Medicaid members can ask for a state fair hearing after their health plan's own appeal.
What if my child has two insurance plans?
One plan pays first, and the second may pay part of what's left. For a child on both parents' plans, the plan of the parent whose birthday comes first in the year usually pays first, and Medicaid generally pays last.
Can I use an HSA or FSA for ABA therapy?
In most cases, you can. The IRS counts therapy received as medical treatment as a medical expense, and HSA and FSA money can pay qualified medical expenses.
Does Alpaca Health take my insurance?
Alpaca Health accepts every plan listed under your state above. The plan checker at the top of this page shows it for your state. If you don't see your plan, fill out our intake form anyway, and we'll check your benefits for free and tell you your options.
Check your coverage
Tell us about your child and your plan. We'll confirm your benefits, handle the approval paperwork, and match you with a BCBA who takes your plan.