fbpx
Athena Care
Does Medicare Cover ABA Therapy?

Does Medicare Cover ABA Therapy?

Jump to Section

Does Medicare Cover ABA Therapy?

While Medicare ABA therapy benefits are nonexistent, and Medicare doesn’t cover ABA therapy for people with autism, that shouldn’t deter you from finding the necessary treatment. There are alternative options, and Athena Care can help you figure out the most ideal one.  

Applied Behavioral Analysis (ABA) therapy is founded on the science of learning and behavior. Typically, it is used to treat Autism Spectrum Disorders (ASD) as part of autism treatment programs and other developmental disabilities.

ABA teaches actions that will make patients’ lives safer and more satisfying.1 It is one of the evidence based therapies that focus on a behavioral approach. This type of treatment can also be conducted as in-home aba therapy.

Licensed psychotherapists that perform ABA therapy help individuals with ASD develop abilities such as:

  • Language and communication skills
  • Social skills
  • Hygiene and self-care practices
  • Leisure and play abilities
  • Motor skills

How to Verify Medicare ABA Therapy Insurance Coverage

Although Medicare ABA therapy coverage does not exist, Athena Care is in-network with most major insurance plans. We accept most commercial policies, except Tennessee’s TennCare (Medicaid), for ABA therapy, depending on the plan and provider.

Filling out our free and confidential online insurance verification form is the best method to determine your options for ABA therapy coverage. Allow our highly qualified care coordinators to contact your health insurance provider for more information about ABA therapy benefits. A care coordinator will review your plan and thoroughly explain your options after you’ve submitted the form. Rest assured that all information shared and discussed is private.

Requirements, Eligibility & Process for Medicare ABA Coverage

Medicare coverage for ABA therapy is not a thing. Still, Athena Care can assist you with different options for receiving the treatment necessary. With that in mind, most insurance companies will require prior authorization for behavioral therapy and autism services in Tennessee. In addition, the following may or may not be required:

  • The supplier offering ABA therapy is a certified behavior analyst.
  • The initial treatment strategy complies with the child’s medical requirements.
  • A licensed diagnostician has given the patient an autism diagnosis.  

How Much Does ABA Therapy Cost Without Insurance?

The average cost of ABA therapy is $120 per hour, and a 30 risperidone, 1 mg oral tablets supply, is about $18. Some children require up to 40 hours of ABA therapy each week to reach their full potential, which costs $4,800 per week or $249,600 per year.2

Forbes estimates that the annual cost of ABA therapy without coverage for autism is about $17,000. It might range from $45,000 to $100,000 annually for some children.3

The CDC estimates that average annual medical costs for a child with one of the autism spectrum disorders are $4,110 to $6,200 higher than for children without the condition.4

Sources

  1. “Questions and Answers About ABA.” Autism Speaks, 11 Aug. 2021, www.autismspeaks.org/blog/questions-and-answers-about-aba.
  2. Tatom, Carol RBT. Autism Parenting Magazine, 2022, “How Much Does ABA Therapy for Autism Cost?” https://www.autismparentingmagazine.com/aba-therapy-autism-cost/
  3. Molko, Ronit. “What Is Covered? The Insurance Landscape for Autism Services.” Forbes, 18 Apr. 2019, www.forbes.com/sites/forbesbooksauthors/2019/04/18/what-is-covered-the-insurance-landscape-for-autism-services/?sh=133bbd3325c2.
  4. “Basics About Autism Spectrum Disorder (ASD) | NCBDDD | CDC.” Centers for Disease Control and Prevention, 31 Mar. 2022, www.cdc.gov/ncbddd/autism/facts.html.

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

(615) 320-1155