How Much Does ABA Therapy Cost? An In-Depth Look at Factors and Coverage
A question we often get from our clients is “how much will my ABA therapy cost?” ABA therapy is typically delivered 1:1 by a trained therapist for more than 10 hours/week. As a result, ABA is expensive. Services typically cost greater than $20K/year. While health insurance plans generally cover much of the cost of ABA, most families can expect to pay their out-of-pocket max. In this post, we delve into what may impact the cost of ABA therapy, with a pitstop explaining how American healthcare reimbursement works. By the way, if you want to learn more about what ABA is, check out this post.
Factors Influencing Cost
Several factors contribute to the amount that a family pays for ABA therapy:
Provider Type: ABA therapy is typically administered by professionals such as Board Certified Behavior Analysts (BCBAs), Board Certified Assistant Behavior Analysts (BCaBAs), and Behavior Technicians (BTs). The qualifications and experience of these professionals influence service costs, with BCBAs generally charging higher fees due to their advanced training and expertise. BT rates are typically in the $50 – 75/hour range and BCBA rates are often $100 – $150/hour.
Intensity and Duration: The recommended intensity and duration of ABA therapy vary based on the individual’s needs and goals. It is common for children with autism to receive between 10-20 hours of direct therapy each week. Some providers recommend up to 40 hours/week of ABA. Direct therapy is generally provided by the Behavior Technicians with BCBAs providing up to several hours/week of supervision and caregiver training.
Insurance Coverage: Insurance coverage for ABA therapy has become commonplace, especially with the passage of autism insurance mandates at the state level. Most Commercial and Medicaid/Medi-cal insurances cover ABA services as a benefit for children diagnosed with ASD. However, coverage specifics vary widely among insurance plans. Families must carefully review their policies to understand coverage limits, copayments, deductibles, and any out-of-pocket maximums that apply.
Understanding the Numbers
In the United States, hourly rates for ABA therapy typically range from $50 to $150 per hour. For families committing to intensive therapy schedules, monthly costs can amount to several thousand dollars.
For example, a 12 hour a week ABA program with an average billable rate of $75 would cost $45,000 annually. Depending on the insurance coverage, individuals should expect to meet an insurance deductible in the first three months of therapy and out of pocket maximum (MOOP) within six months. You can find your deductible, copay, coinsurance, and MOOP information on your health insurance Summary of Benefits and Coverage document. An example of one is provided here.
Despite these expenses, many families find the investment worthwhile due to the significant improvements in their loved ones’ behaviors, communication skills, and independence.
Navigating Costs and Coverage
Managing the costs associated with ABA therapy requires proactive steps:
Insurance Verification: Contact your insurance provider to verify coverage details specific to ABA therapy. Typically, your health plan’s member services line will be listed on the back of your insurance card. These services are typically covered under behavioral health treatment (BHT), outpatient behavioral health, or specialty care. Understand what your financial responsibilities are (e.g., copayments or coinsurance), and any limits on the number of sessions or total coverage amount.
Provider Selection: Research ABA providers in your area thoroughly. Compare costs, credentials, and services offered. Seek recommendations from other families or healthcare professionals familiar with autism treatment options in your area. Verify that the provider you’ve chosen is in-network with your insurance.
Advocacy and Support: If you encounter challenges with insurance coverage or accessing affordable ABA therapy, advocacy groups and autism organizations can offer guidance. They may assist in navigating insurance claims, appealing coverage denials, and advocating for improved insurance policies at local or state levels.
Conclusion
While the cost of ABA therapy presents a significant financial consideration for families, its potential to improve quality of life and enhance skills cannot be overstated. By understanding the factors influencing costs, exploring one’s health plan coverage, and comparing provider rates and service offerings, families can make informed decisions that prioritize the well-being of their loved ones with ASD.
