The costs of ABA therapy vary somewhat from state to state. Factors that affect the overall cost include the cost of living in the area as well as the provider’s education, certification level, and experience.

In general, ABA therapy costs in the range of $120 for a one-hour session. Most insurance plans will cover this therapy, so the cost can largely be offset by insurance coverage. This means your out-of-pocket expenses will be greatly reduced.

Talk to your insurance provider and ABA therapist to get an exact about that you will be expected to pay for ABA therapy sessions.

How ABA Therapy Benefits Children With Autism

You want the best therapy options for your child after they receive an autism diagnosis. ABA therapy is an intensive therapy that may require up to 40 hours per week of therapy , but children who receive this concentrated treatment see successful outcomes.

It’s well established that people who are on the autism spectrum benefit from a ccess to applied behavior analysis (ABA) therapy . This approach to treating developmental disorders has been used since the 1950s. It uses objective measurements of behavioral change to determine whether the client is improving their ability to socialize, communicate, and learn.

ABA therapists can work in a range of settings, such as on a one-on-one basis with clients in their homes, in larger medical clinics, in schools, and even in workplaces. Most people with autism benefit from regular, intensive, and individual therapy, but wider access is important.

For people with autism, working individually with an ABA therapist supports their learning process through clear, measured steps with achievable goals. This means that accessing this care for children with autism is important.

Health Care Coverage for Applied Behavior Analysis Therapy

Paying for ABA therapy out of pocket can appear to be a daunting task. Fortunately, many states have passed laws regulating health insurance companies, requiring that they provide coverage for evidence-based treatments like ABA therapy. This can help to offset the cost not only every year, but for the entirety of the individual’s life.

As of 2020, nearly every state in the United States requires many insurance companies to cover the cost of autism treatment, although the exact coverage will depend on what type of insurance you have. For example, your employer-based insurance may not cover it, but government insurance plans will cover a lot of the cost.

Your out-of-pocket expenses will vary based on your local cost of living and whether applied behavior analysis (ABA) therapy is part of a larger treatment program like special education.

The Annual Cost of ABA Therapy

There is no known cure for autism , but there are many treatments that can greatly improve the quality of life for someone on the autism spectrum. These all involve access to health care to some extent, so these treatments are often covered by insurance policies because they are deemed medically necessary.

The specifics of coverage vary from plan to plan. Get to know the specifics of your particular plan to determine the exact level of coverage you can expect for ABA therapy. Even if ABA therapy is covered, you will still have some out-of-pocket costs, such as copays, co-insurance, and deductibles to meet.

The Centers for Disease Control and Prevention (CDC) estimates that children with autism require an additional $17,000 more per year in care compared to children who are not autistic. Children with severe autism, which can impact motor skills, cognitive function, and verbal communication, may need an additional $21,000 per year compared to their neurotypical peers. 

Typical costs involve:

    • Overall health care costs, including regular visits to a pediatrician.

    • Education costs, which may include special education or afterschool programs.

    • Autism-related therapy costs, including ABA therapy, occupational therapy, and speech therapy.

    • Family services, including family therapy.

    • Additional caregivers.

How Laws Mandate Coverage

Many states in the United States require health insurance companies to cover costs associated with autism treatment, and this coverage might last for a lifetime.

As of June 2017, the District of Columbia and 46 states mandated that insurance companies cover autism treatment through laws that have been passed. Some states require more limited autism treatment coverage, through mental health treatment requirements or related laws. At least 30 states have mandates for coverage of autism-related costs in their health care exchanges, which were enacted as part of the Affordable Care Act (ACA).

About 45% of large companies, which have 500 employees or more, include coverage for ABA therapy, among some other intensive behavior therapies, in their employer health plans or self-funded plans. Children whose families qualify for Medicaid can also receive ABA therapy as one of the covered treatments for autism.

About 200 million people now have coverage for ABA therapy, thanks to nonprofit work demanding equal medical treatment and access. As of 2020, all 50 states in the U.S. require health insurance providers to cover ABA treatment , but this is for fully funded insurance plans. Self-funded plans do not have this requirement since these plans are regulated by the federal government rather than the states.

This means that where you live can impact the amount of coverage you receive, what is covered, and for how long. This is a potential complication to understand, on top of understanding the costs of the different types of treatment that may be needed over the course of an autistic person’s life. 

Varying Costs in Care Based on Need & Type

Autism is a spectrum disorder, meaning that people who are diagnosed as autistic have a range of needs based on the severity of the condition.

Many adults with autism continue to need ABA therapy to understand nonverbal communication or manage their stress when changes occur. Ultimately, an autism diagnosis means higher lifetime costs compared to someone who is considered neurotypical.

People who are severely autistic will need much higher levels of physical and emotional care. For example, people who have trouble taking care of their daily needs due to cognitive and motor skills problems may require: 

    • Community care facilities with 24/7 nursing access, which can cost over $43,000 per year.

    • Daycare programs, which can amount to over $11,000 per year.

    • Out-of-home care, which can cost more than $5,200 per year.

    • In-home care, which can cost about $3,000 on average per year.

    • Employment support, including education and skills training, which can average around $5,000 per year.

    • Other services, including crisis management, behavioral treatment, and home health agency services, which can cost an average of $13,500 each year.

For ABA therapy, the costs will also vary according to the skill, certification, and experience level of the provider. Generally, BCBA-Ds have the highest rates since these professionals have a doctoral-level degree. BCaBAs tend to be less expensive than BCBAs since they are assistant BCBAs.

While BCBAs and BCBA-Ds assess the client and design the overall treatment plan, the therapy is often performed by registered behavior technicians (RBTs). RBTs are always supervised by BCBAs or RBT supervisors. Because RBTs are entry-level positions with fewer qualifications, these professionals make less than BCBAs .

Each ABA provider will price their services slightly differently, depending on which professional is delivering the exact service. Make sure to inquire beforehand so there are no financial surprises later. 

The Most Supportive States for ABA Treatment for Autism

In addition to insurance mandates for autism treatment coverage costs, some states are more supportive of people with autism by offering government or nonprofit funds to help residents pay for the costs of ABA therapy.

According to an article published in Autism Parenting Magazine , these are the top 10 most supportive states for autism health care coverage and treatment access:

  • California: The Golden State has no age or coverage limit, requires ABA therapy coverage for all insurers in the state, and offers grants to offset treatment costs.
  • Massachusetts: This state provides the same access and benefits as California, including requiring ABA therapy coverage.
  • Indiana: This state also offers grants, has no age or coverage limit, and requires ABA therapy coverage.
  • Colorado: There is no age or coverage limit. The state requires that insurers cover ABA therapy, but does not offer grants to offset health care costs.
  • Vermont: The state mandates coverage for children with autism until they are 21 years old, requires ABA therapy coverage, has no coverage costs limit, and provides multiple grants.
  • Maryland: Children with autism are covered until age 19, but otherwise, the state is similar to Vermont.
  • New Jersey: Like Vermont, New Jersey covers children until 21 years old, has no coverage limit, and offers a range of grants. New Jersey does not require ABA therapy to be covered by insurance, however.
  • Washington: The state offers similar benefits to California, but does not offer grants to help with costs.
  • New Hampshire: The state covers children with autism until they are 21 years old, has some restrictions on coverage costs based on age, provides grants to offset costs, and does not require ABA therapy to be covered by insurance providers.
  • New York: There is no age limit to coverage, but the state only allows up to $45,000 in coverage costs. They do offer grants and require ABA therapy coverage.

Whether you live in one of these states or not, you can contact your state’s Department of Health and Human Services, work with your child’s pediatrician and other specialists, or contact the Behavior Analysis Certification Board (BACB) for recommendations and support. These resources can help you navigate the costs of ABA therapy and understand how insurance coverage for this therapy works.

While the initial effort to break down the costs of ABA therapy can feel overwhelming, there are resources available to help.

References