The Best Insurance Plans in New York and New Jersey that Cover ABA Therapy
Kids with autism spectrum disorders suffer from a number of conditions that make it difficult to function socially and emotionally in the real world. Additionally, attempting to get them to work more and do more work alongside their non-challenged or “normal” peers requires time and patience to build. These skills can be applied to ABA therapy.
ABA or Applied Behavioral Analysis therapy is the means of assessing the splinter skills that a child on the spectrum has, and then using different means of increasing and improving those skills. It is best to start as soon as possible after your child is diagnosed with an autism spectrum disorder, but not everyone is capable of doing so. The sessions are usually conducted in your home so that your child feels safe and in his or her “safe zone.”
In some states, the therapy is not covered by any insurance whatsoever, leaving the expense to the parents who probably cannot afford it. Thankfully, in New York and New Jersey, there are insurance companies that can and will cover this therapy if it is deemed necessary for your child’s growth and development. Here are the best insurance plans for covered ABA therapy coverage in New York and New Jersey.
CIGNA is an insurance provider based in Connecticut. Depending on your plan, ABA may be covered according to the number of sessions (e.g., 24 sessions per calendar year), or charged and covered individually based on need and frequency. If you have CIGNA, you will need to login and check with available and covered providers in your area.
There are multiple plans available under this insurance company in the New Jersey/New York area. The most common is the CHIP or Medicaid plans, which automatically cover children with pre-existing conditions (i.e., autism). Home visits are covered when needed, as is respite care if you are an exhausted parent who needs a break from caring for your child with ASD. Because the home visits are paid for, whatever is accomplished with your child during the home visit is also covered.
Oxford Insurance is based in New Jersey and New York, and it only offers insurance plans in these two states. There are a couple of different plans you could choose, but a child health insurance plan or a child health insurance expense account is the most recommended. The expense account allows you to put aside tax-free dollars to care for your child’s needs, including ABA therapy. The insurance covers medically necessary care for your child’s well-being. Discuss the benefits at length with your Oxford Insurance agent before choosing the plan that is right for you and your child with ASD.
Aetna’s approach to ABA therapy coverage is a little different from other plans, but at least you know that the therapy is still covered. This insurance company has a set of specific criteria that must be met before ABA home care and in-home ABA therapy is covered under this insurance company’s plans. If your doctor deems it medically necessary for the well-being and development of your child, Aetna will cover the therapy.
Blue Cross and Blue Shield
This insurance company used to be two insurance companies but merged some years ago. As their name suggests, the original two companies were Blue Cross and Blue Shield. Under this insurance, you may need to take a few extra steps before your child with ASD can begin receiving ABA therapy.
The first step is a confirmed diagnosis of autism. The next step requires that you get a “functional behavior assessment” and provide the results to Blue Cross/Blue Shield of New York/New Jersey. Then you can obtain a preauthorization to begin therapy. Not all of the plans offered by Blue Cross and Blue Shield of New York or New Jersey will cover ABA, so it is important to consult with a telephone representative to choose the right policy if you are signing up online.
Oscar is a New York-based, New York only insurance company providing private health insurance plans to people living in the state of New York. There are over fifty gold, silver, and bronze plans available, but in order to find the plans that cover ABA therapy, you will need to request a quote and/or request a personalized plan. The personalized plan is a nice feature since it helps you zero in on a plan that will cover this therapy for your child.
A Word on Signing up Directly or Through the Marketplace
Each of the above insurance companies will provide you with a plan and help you cover the costs for ABA. However, the next step before you sign up is deciding if you will sign up directly with the insurance company, or sign up through the federal Marketplace. It helps to compare the same or similar plans on both the Marketplace and on the company’s own website so that you can see what is and is not covered, and the price differences.
Additionally, if your income cannot cover the costs of the insurance plans that cover ABA, then buying through the Marketplace might help. There are financial assistance plans in place to subsidize the monthly premiums of the available plans. It may help you afford the insurance plan that will cover the therapy your child needs. Of course, if you are extremely low income, your child(ren) already qualify for free healthcare coverage through state Medicaid programs.
Ask an intake worker in your state’s department of social services to see if in-home ABA therapy services are covered by Medicaid. If these services are not covered by Medicaid directly, getting a referral from a doctor to state that ABA is medically necessary can get the services covered. If that does not work, then you will have to buy insurance for just the child with ASD so that you can start the therapy your child needs.