What autism therapies are covered by health insurance?
Over the last 2 decades, all 50 states have passed mandates requiring the coverage of healthcare services for children with autism by private health insurance companies. This has led to increased coverage and access to care for families across the US. Specific mandates for autism care vary by state and insurance plan type.
For instance, Colorado has a state insurance mandate (SB 09-244) that was first passed in 2009 and then revised in 2015 (SB 15-015) to remove caps on coverage. The mandate covers most private health insurance plans in the state, and Colorado Medicaid (also known as Health First Colorado) and TRICARE also provide coverage.
It supports access to autism care by ensuring diagnostic and evidence-based treatments are covered by health insurance. To see if a provider is covered by your health insurance, ask the provider’s office staff, who can confirm whether they’re in-network based on your plan.
How much out of pocket cost will I have?
Your specific out of pocket costs will vary based on the details on your child’s health insurance plan. If you are interested in therapy at Soar, reach out to our team and we can provide a specific out of pocket cost estimate.
In general, the common parts of your insurance plan that will impact your cost are the following:
- Deductible. This is the amount that you have to pay out of pocket each year before your insurance coverage begins. For instance, if your plan had a $1,000 deductible, this would mean you would have to pay $1,000 directly to a provider before your insurance company begins paying.
- Co-payment or co-insurance. Once you’ve met your deductible, most plans will have a co-payment or co-insurance for each day of therapy. Co-payments are a fixed amount per day, so if you had a $25 co-pay in your plan, you would pay $25 for each day of therapy (and your insurance company would pay the remaining amount). Co-insurance is a percentage of the total cost, so if you had a 20% co-insurance, you would pay 20% of the bill from your provider (and your insurance company would pay the remaining 80%).
- Out of pocket maximum. Many plans have an out of pocket maximum after which the insurance will cover all of the costs of therapy. For instance, if your plan had a $3,000 out of pocket maximum, after you spent $3,000 in a year on your child’s care, insurance would cover 100% of the remaining costs (i.e. you wouldn’t have to pay any co-pays or co-insurance).
For questions about your specific plan, reach out to your therapy provider for a more specific cost estimate.