Health Insurance Coverage for Autism

Autism Speaks Advocacy on Health Insurance Coverage of Autism Therapies

At least 200 million people now have health insurance coverage for ABA due to our efforts and dedicated advocates across the country.

Over the last decade, the Autism Speaks advocacy team has focused on improving health insurance coverage for medically necessary treatments such as Applied Behavior Analysis (ABA).

Health insurance can be very complicated. The time and energy often needed to ensure that prescribed treatments are covered can complicate what may already be a stressful time for families faced with a diagnosis of autism.

We are here to help.

Our online resources and staff can help you determine if your health benefit plan provides meaningful coverage for the treatment of autism. We can also assist with effective implementation and enforcement of the benefits to which you are entitled.

Health benefit plans

The first question we need to ask is, “Which type of health benefit plan do you have?”

If you don’t already know what type of health benefit plan you have, please refer to our Health Benefits Guide. If you have trouble or need additional information, contact us at advocacy@autismspeaks.org.

Once you have confirmed your plan type, find more information on your plan's page in the sidebar on the left.

Why do I need to know the type of health benefit plan I have?

Your type of plan determines which health benefits must be covered.

• Some plan types (e.g., “fully insured plans”) must provide benefits directed by state law while other plan types do not.
• All fifty states have taken government action to require coverage for ABA.
• Fully insured plans must comply with these laws, but self-funded plans do not. Self-funded plans are regulated by federal law – not state law.

Your type of plan impacts how you advocate for a change in benefits.

• Subject to state and/or federal law, benefits are determined by the employer in self-funded plans but by the insurance company in fully insured plans.
• If you are covered by a self-funded plan, you would advocate at the level of your employer.
• If you have a fully insured plan, your employer has no control over plan design. It is usually necessary to advocate for a change in state law.

Your type of plan may affect how to appeal denials of coverage and to whom you file complaints if you are not satisfied with implementation of benefits.

To the best of our ability, this information is accurate and up to date, but it is up to the consumer to investigate fully before making any decisions regarding health care coverage.

Last Updated: September 2019