Navigating the world of applied behavior analysis (ABA) therapy, especially the cost and insurance piece, can feel overwhelming. For many families, ABA is a medically necessary, evidence-based intervention that supports their child with autism by developing meaningful skills. Yet, therapy costs can vary widely from family to family and insurance to insurance. In this post, we break down the realities of cost, explore how Medicaid and private insurance can help, and how our team works with families to make this care accessible.

Why Costs Are So Different From Person to Person

ABA therapy is not a one-size-fits-all service, and that’s one of its greatest strengths. Each child’s program is individualized based on their needs, goals, recommended number of weekly hours, and the level of clinical oversight required. Because of this, the cost of ABA therapy will look different from one family to the next.

Other factors also play a role, including the child’s age, where services are provided (clinic, home, school, or community), geographic location, and the type of insurance coverage a family has. All of these variables contribute to why there isn’t a single standard cost for ABA therapy. They also exemplify why taking steps, such as speaking with your insurance provider and our team, to help you understand your specific benefits, is so important.

Medicaid Coverage: A Critical Safety Net

For many families, Medicaid provides essential coverage for ABA therapy. Under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, Medicaid is required by federal law to cover medically necessary services, including ABA, for eligible children. 

This means that Medicaid typically covers ABA therapy for children diagnosed with Autism Spectrum Disorder up to age 21. Coverage details, such as required documentation, authorization processes, and provider networks, still vary by state.

Medicaid coverage dramatically reduces the financial burden many families would otherwise face, making therapy accessible regardless of income level.

Private Insurance: Copays, Deductibles, and Out-of-Pocket Costs

Most state-regulated private health insurance plans now include ABA therapy coverage thanks to advocacy and state mandates. But coverage doesn’t always mean “zero cost” for families.

Here’s how private plans typically shape out financially:

• Copays: Some plans require a fixed copay for each therapy session, similar to what you might pay for other health services. The amount can vary by plan.

• Deductibles and Out-of-Pocket Maximums: Other plans count ABA therapy toward your deductible and out-of-pocket max. That means you may pay full or partial costs until your deductible is met. After that, the plan often pays a large percentage of the cost, but you might still owe coinsurance until your annual out-of-pocket maximum is reached.

For some families, once the out-of-pocket max is met, additional ABA services for the year may be fully covered. These thresholds can significantly influence what you pay monthly and yearly in real terms. Because policies vary so much, it’s important to review your specifics with our team and your insurer!

How We Run Insurance Benefits at STEPS Behavioral Health

One of the most helpful things STEPS Behavioral Health’s experienced billing team does for families is an insurance benefits verification. A Verification of Benefits (VOB) is a report from your insurance company that shows what services are covered, the extent of coverage, and any requirements (like prior authorizations). It’s not a guarantee of payment, but it is a solid estimate based on plan parameters at the time. 

Here’s how it works on our end:

1. Our STEPS team will gather your insurance information.
   This includes member ID, plan details, and authorization requirements.

2. The team will run a benefits check with your insurer.
   This tells them what services are covered, any limits (like session caps or age restrictions), details about copays, and whether prior authorization is required.

3. The team will translate the results for you!
   Insurance language can be confusing. They’ll provide you with a plain-language summary of what your plan covers and what it means for your costs, including how much you may need to pay out-of-pocket before benefits begin and what the copay or coinsurance will be per session or per day. STEPS also encourages families to receive a copy or confirmation from the insurer when possible. A shared understanding builds trust and teamwork. 

Working Together on Payment Plans and Support

Working as a team helps avoid surprises and ensures you feel informed and supported throughout the process. Sometimes, even with insurance, families may face financial responsibility through copays, deductibles, or coinsurance. When that happens here at STEPS, we offer collaborative approaches:

• Payment Plans – If a family is expected to pay out-of-pocket amounts that might be difficult to manage all at once, we work with you to create a reasonable payment plan that spreads patient responsibility into smaller, manageable payments throughout the year, and that fits your budget while keeping therapy consistent.

• Grants and Financial Assistance – We also maintain information about available external grants and are continually learning about new funding opportunities, which we are happy to share with families whenever possible. These programs can sometimes help cover therapy costs or support periods while insurance approvals are pending. 

Our goal is to ensure access for as many families as possible, not to delay or deny care due to cost. This is not something we want you to navigate on your own; it’s a partnership.

In Conclusion, You’re Not Alone in This

Affording ABA therapy doesn’t have to be an insurmountable challenge. With Medicaid, many families receive significant support under federal and state mandates. For those with private insurance, understanding how copays, deductibles, and out-of-pocket maxes work empowers you to plan. And when costs are still a concern, our team is here to help you with verification, insurance guidance, payment plans, and finding additional support.

At STEPS, we realize that ABA therapy is not just a clinical path, but also a journey you take with a care team, equipped with clear information, practical tools, and a shared commitment to your child’s progress.

If you’re ready to begin or have questions about how this applies to your situation, we’re here to walk alongside you, STEP by STEP!