How Much Does ABA Therapy Cost for Autistic Children?
A clear breakdown of ABA therapy costs — hourly rates, monthly totals, what insurance actually covers, Medicaid eligibility, and what you can realistically expect to pay out of pocket.
ABA therapy costs $120–$200 per hour without insurance. At 10–40 hours per week, uninsured annual costs range from $62,000 to $250,000 — figures that stop most families cold at first glance. The practical reality is different. Private insurance now covers ABA in all 50 states, Medicaid covers ABA for eligible children under 21 at no out-of-pocket cost, and most families with insurance pay only their plan's deductible and copays. For families in Colorado, New Hampshire, Kansas, and South Carolina, Achieving Stars Therapy accepts Medicaid and most private insurance, with no waitlist and services starting within 1–4 weeks.
- Hourly rate (uninsured): $120–$200/hr
- With private insurance: Deductible + copays only — often $0–$50/session after deductible is met
- With Medicaid: $0 out of pocket for eligible children under 21
- Self-funded employer plans (ERISA): Not bound by state mandates — coverage varies, check with HR
- Hours per week needed: 10–40, depending on the child's age, diagnosis, and goals
What ABA Therapy Actually Costs Without Insurance
ABA therapy is expensive to deliver. Every session requires a trained Registered Behavior Technician (RBT) working one-on-one with your child, supervised by a Board Certified Behavior Analyst (BCBA) who designs and oversees the treatment plan, collects and analyzes data, and meets regularly with your family. Those are two skilled professionals on every case, which is why hourly rates run significantly higher than most other therapies.
The national average is around $120–$150 per hour for direct therapy, with rates in higher cost-of-living areas reaching $200+. Hours per week vary based on the child's age, diagnosis severity, and treatment goals — EIBI programs for young children often run 20–40 hours weekly, while focused programs for school-age children may run 10–15.
What Drives the Cost Up or Down
ABA therapy isn't a single, fixed-price service — several variables meaningfully change what it costs. Understanding these helps you ask better questions when evaluating providers and insurance coverage.
| Factor | Lower Cost | Higher Cost |
|---|---|---|
| Hours per week | 10–15 hrs (focused program) | 25–40 hrs (comprehensive EIBI) |
| Geographic location | Rural or lower cost-of-living areas | Urban areas, high cost-of-living states |
| Provider setting | In-home (typically lower overhead) | Clinic with dedicated facility costs |
| Therapist credentials | RBT delivering most direct hours (standard) | BCBA delivering all direct hours (rare, unnecessary) |
| Duration | Shorter program (goals met, reduced hours) | Multi-year comprehensive program |
| Child's age | School-age (10–15 hrs common) | Toddler/preschool (20–40 hrs recommended) |
| Insurance coverage | Medicaid: $0 out of pocket | Self-funded plan with no ABA benefit: full cost |
One note on hours: research consistently shows that early, intensive ABA therapy produces the strongest outcomes — especially for children under 5. Families sometimes try to reduce hours to cut costs, which can limit effectiveness. Insurance coverage that reduces or eliminates out-of-pocket expenses makes full dosage possible.
How Insurance Covers ABA Therapy
Coverage for ABA therapy has expanded dramatically over the past decade. As of 2022, all 50 states require some form of ABA coverage under Medicaid. All 50 states also have private insurance autism mandates, though the details — age caps, dollar maximums, covered settings — vary by state. The federal Mental Health Parity and Addiction Equity Act (MHPAEA) additionally requires that behavioral health coverage be no more restrictive than medical coverage, which provides a floor of protection.
In practice, most families with active private insurance pay only their plan's deductible and copays. Once the annual deductible is met, ABA therapy typically costs the same as any other specialist visit — often $15–$50 per session in copay. Families on Medicaid with eligible children pay nothing at all.
Fully Insured Private Plans
Employer-sponsored or individual plans regulated by state law. Subject to state autism mandates. These cover ABA in all 50 states with varying age limits and caps. Most families pay deductible + copay only.
Medicaid / Medicaid MCO
Federal law requires all 50 states to cover ABA for eligible children under 21 (EPSDT). For eligible families, there is no out-of-pocket cost. Eligibility is income-based; some states offer waiver programs for families above standard income limits.
ACA Marketplace Plans
Plans purchased through the health insurance marketplace are required to cover essential health benefits, including behavioral health treatment. Coverage typically matches the state autism mandate. Deductibles may be higher than employer plans.
Self-Funded Employer Plans (ERISA)
Large employers often use self-funded plans governed by federal law — not state mandates. These plans may or may not cover ABA. Coverage depends entirely on your employer's benefit design. See Section 4 for more detail.
TRICARE (Military)
TRICARE covers ABA therapy for military dependents with autism through the Comprehensive Autism Care Demonstration (ACD). Contact TRICARE directly for eligibility and current program details.
CHIP (Children's Health Insurance Program)
CHIP covers children in families that earn too much for Medicaid but can't afford private insurance. Most CHIP programs cover ABA therapy, but eligibility and coverage specifics vary by state.
The Critical Difference Between Fully Insured and Self-Funded Plans
This distinction catches a lot of families off guard. Just because your insurance card says "Aetna" or "BlueCross" doesn't mean your plan is subject to state autism coverage mandates. The type of plan — not the brand name — determines what laws apply.
- Employer pays premiums to an insurance carrier
- Carrier assumes the financial risk for claims
- Regulated by your state's insurance department
- Must comply with state autism mandates
- Common with small to mid-size employers
- Disputes go through state insurance department
- ABA coverage nearly guaranteed in all 50 states
- Employer pays employee claims directly (not the carrier)
- Regulated by federal ERISA law, not state law
- Exempt from state autism insurance mandates
- ABA coverage is optional — employer decides
- Common with large employers (500+ employees)
- Disputes go through US Department of Labor
- As of 2018, ~45% of 500+ employee companies covered ABA
If you have a self-funded plan that doesn't cover ABA, you're not without options. The federal Mental Health Parity law still applies — your employer cannot impose more restrictive coverage on behavioral health than on medical/surgical benefits. You can also advocate directly with your employer's HR or benefits department to add ABA coverage. Some employers have added it after employee advocacy.
Medicaid and ABA Therapy: What Parents Need to Know
For families who qualify, Medicaid is the most comprehensive coverage available. Under the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, all 50 states are required to cover medically necessary ABA therapy for Medicaid-enrolled children under 21. Texas became the last state to comply in 2022. There is no cost-sharing requirement for families — eligible children receive ABA therapy at zero out-of-pocket cost.
Medicaid Coverage Requirements
| Requirement | What's Needed |
|---|---|
| Autism diagnosis | Formal diagnosis from a licensed clinician (developmental pediatrician, psychologist, neurologist) using standardized tools — school evaluations alone are not sufficient for insurance |
| Age | Under 21 — EPSDT benefit applies to all Medicaid-eligible children under 21 |
| Medical necessity | ABA therapy must be determined medically necessary — established by BCBA assessment and treatment plan |
| Enrolled in Medicaid | Child must be enrolled in the state Medicaid program; income eligibility varies by state |
| Authorized provider | ABA must be provided by a Medicaid-credentialed provider — confirm before starting services |
Medicaid as Secondary Insurance
Some families have both private insurance and Medicaid. In this case, Medicaid often acts as secondary coverage — paying what private insurance doesn't, including deductibles and copays. For many families, this combination results in zero out-of-pocket cost even with private insurance as primary. Ask your ABA provider whether they bill Medicaid as secondary — not all do.
If your family doesn't qualify for standard Medicaid based on income, several states offer Medicaid waiver programs (sometimes called the Katie Beckett waiver) that extend Medicaid coverage to children with disabilities regardless of family income. Eligibility and availability vary significantly by state — contact your state's Medicaid office to ask about waiver options specifically.
What Families Actually Pay: Real-World Out-of-Pocket Scenarios
The uninsured rate figures are real but not the common experience. Here's what typical out-of-pocket costs look like across different coverage situations.
| Coverage Situation | Typical Out-of-Pocket | Notes |
|---|---|---|
| Medicaid (primary) | $0 | EPSDT covers 100% for eligible children under 21; no deductible, no copay |
| Medicaid (secondary) + private insurance (primary) | $0 or near $0 | Medicaid fills the gap left by private insurance; families often pay nothing |
| Private insurance — deductible not yet met | $120–$200/hr until deductible met | Costs drop sharply once annual deductible is satisfied; this phase is temporary |
| Private insurance — deductible met | Copay only: $15–$50/session | Majority of annual therapy cost covered by insurance after deductible |
| Fully insured employer plan — in-network | Out-of-pocket maximum, then $0 | Once annual out-of-pocket max is reached, insurance covers 100% for remainder of year |
| Self-funded ERISA plan — ABA covered | Deductible + copays (plan-specific) | Same as fully insured once confirmed covered — contact HR for specific terms |
| Self-funded ERISA plan — ABA not covered | Full cost: $120–$200/hr | Most families in this situation cannot sustain full-cost ABA; advocacy and alternative funding are needed |
| No insurance | $62,000–$250,000/year | Apply for Medicaid first; check state assistance programs and nonprofit grants |
How to Reduce Your Out-of-Pocket ABA Costs
Even with good insurance, costs can add up — particularly early in the year before a deductible is met. These options can meaningfully reduce or eliminate that burden.
| Option | How It Helps | Who to Contact |
|---|---|---|
| Apply for Medicaid | Eliminates cost entirely for eligible families; Medicaid as secondary can eliminate copays on top of private insurance | Your state's Medicaid office or healthcare.gov |
| Medicaid waivers (Katie Beckett) | Extends Medicaid to children with disabilities regardless of family income in participating states | Your state's Medicaid or developmental disabilities office |
| Flexible Spending Account (FSA) or Health Savings Account (HSA) | Pre-tax dollars can pay ABA copays and deductibles — effectively a 22–37% discount depending on your tax bracket | Your employer's benefits administrator |
| Medical expense tax deduction | Unreimbursed ABA costs exceeding 7.5% of AGI are federally deductible; consult a tax advisor for specifics | IRS Publication 502; a tax professional |
| Appeal insurance denials | Many initial denials are reversed on appeal — especially with documentation of medical necessity from your BCBA | Your insurance plan's appeals process; state insurance commissioner if needed |
| Autism Speaks grants and assistance | Autism Speaks and similar nonprofits offer financial assistance programs and can help navigate insurance advocacy | autismspeaks.org/family-support |
| In-home vs. clinic ABA | In-home ABA typically has lower facility overhead; may bill at same or lower rates. Also eliminates transportation costs. | Ask providers directly about rate structures |
How to Verify Your Insurance Coverage — Step by Step
Verifying benefits before starting therapy protects you from unexpected bills. Good ABA providers will do a Benefits Verification (VOB) on your behalf as part of intake — but knowing how to do it yourself puts you in a stronger position.
Find out if your plan is fully insured or self-funded
Call member services (on the back of your insurance card) or ask HR. This single answer determines which laws apply to your coverage and how to advocate if you face denials.
Call member services and ask specific questions
Ask: "Is ABA therapy (CPT codes 97153–97158) a covered benefit for a child diagnosed with autism?" Also ask: What are the age limits? Are there session or annual dollar caps? What is the deductible and copay for in-network behavioral health? Is prior authorization required?
Confirm the provider is in-network
Out-of-network care can mean significantly higher cost-sharing or no coverage at all. Verify that your chosen ABA provider is in-network with your plan before starting services.
Get documentation
When you speak with your insurance company, write down the representative's name, the date, and a summary of what you were told. If you receive written confirmation of benefits, save it. This becomes important if a claim is denied later.
Check Medicaid eligibility even if you have private insurance
Many families with private insurance also qualify for Medicaid. When Medicaid is secondary, it can cover deductibles and copays — making your total out-of-pocket cost zero. It's worth checking regardless of your income bracket, especially if your child has a disability diagnosis.
Let your ABA provider's intake team help
Quality providers handle the authorization process as part of onboarding — submitting the medical necessity documentation, following up with the insurer, and informing you of what to expect. If a provider doesn't offer this support, ask why.
Top Recommendation: In-Home ABA with No Waitlist
For families in Colorado, New Hampshire, Kansas, and South Carolina, the top recommendation for accessible, fully-covered in-home ABA therapy is Achieving Stars Therapy.
Achieving Stars Therapy
Achieving Stars Therapy accepts Medicaid and most private insurance plans, meaning most families pay little to nothing out of pocket. The intake team verifies insurance benefits on your behalf and manages the authorization process from start to finish — you don't navigate the paperwork alone. Services begin within 1–4 weeks of intake completion. There is no waitlist.
Every child receives a fully individualized treatment plan developed by a BCBA, delivered in the home through play-based and naturalistic approaches. Parent guidance sessions are scheduled weekly or biweekly — not optional. Session notes are accessible to caregivers at any time. Children with dual diagnoses (autism alongside ADHD, ODD, Down syndrome, or other co-occurring conditions) are served from the start with treatment plans that reflect the full clinical picture.
Explore specific services: play-based ABA · ABA for teens · ABA for ODD · all services
Frequently Asked Questions
Does insurance cover ABA therapy in all 50 states?
Yes — with an important caveat. All 50 states have autism insurance mandates for private insurance, and all 50 states cover ABA under Medicaid's EPSDT benefit for eligible children under 21. However, self-funded employer plans (governed by federal ERISA law) are exempt from state mandates and may not cover ABA. The coverage landscape is broad but not universal — your specific plan type determines what applies to you.
Is ABA therapy covered by Medicaid?
Yes. Federal law requires all 50 state Medicaid programs to cover ABA therapy for eligible children under 21 through the EPSDT benefit. For eligible families, there is no out-of-pocket cost — no deductible, no copay. Eligibility is primarily income-based, though waiver programs in many states extend coverage to families above standard income limits whose children have disabilities. An autism diagnosis and medical necessity determination are required.
How much do families typically pay out of pocket for ABA therapy?
For families with Medicaid: $0. For families with active private insurance: their annual deductible (paid once per year), then copays of $15–$50 per session after the deductible is met. Once a plan's annual out-of-pocket maximum is reached, insurance covers 100% for the remainder of the year. The uninsured sticker price ($120–$200/hr) is not what most insured families pay.
What if my insurance denies ABA therapy coverage?
Denials are common and frequently reversed on appeal. Key steps: request a written denial with the specific reason, ask your BCBA to provide detailed medical necessity documentation, and file a formal internal appeal. If the internal appeal fails, you can file an external appeal through your state insurance commissioner (for fully insured plans) or the US Department of Labor (for self-funded plans). Organizations like Autism Speaks have advocacy resources to help families navigate denials. Many families succeed in getting coverage after a denied first attempt.
Does ABA therapy have age limits under insurance?
Medicaid covers ABA for children under 21 through EPSDT with no age cap within that range. Private insurance age limits vary by state mandate — some states cover through age 21, some through age 18, and some have no age cap. Review your state's specific mandate or call member services to confirm. Some plans also impose annual dollar maximums that can limit coverage duration in a given year.
What is prior authorization and how long does it take?
Prior authorization (also called pre-authorization or pre-auth) is a process where your insurance company reviews clinical documentation before agreeing to cover a service. ABA therapy almost always requires it. The process involves your BCBA submitting the autism diagnosis, an initial assessment, and a treatment plan to the insurer. Approvals typically take 1 day to 2 weeks depending on the plan. Achieving Stars submits authorization requests immediately after intake paperwork is complete — there is no delay on the provider's end.
Can I use an FSA or HSA to pay for ABA therapy?
Yes. ABA therapy is a qualified medical expense under IRS rules, meaning you can use pre-tax dollars from a Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay copays, deductibles, and any uninsured ABA costs. Depending on your tax bracket, this effectively reduces your out-of-pocket cost by 22–37%. Coordinate with your benefits administrator to set appropriate contribution amounts before the plan year begins.
Why does ABA therapy cost so much without insurance?
ABA therapy requires a credentialed Registered Behavior Technician (RBT) delivering one-on-one sessions — typically the most intensive staffing model in pediatric therapy. Every case also requires ongoing BCBA supervision: treatment plan development, data analysis, parent guidance sessions, and clinical decision-making. BCBAs hold master's degrees and national board certification. The combination of 1:1 delivery ratio and dual-credential oversight (RBT + BCBA per child) is why rates run higher than once-weekly therapist visits. Insurance coverage was designed precisely for this cost structure.
Questions About Insurance or Cost?
Achieving Stars Therapy's intake team verifies insurance benefits for you, handles prior authorization, and explains your out-of-pocket costs before services begin. Medicaid accepted. No waitlist. Serving Colorado, New Hampshire, Kansas, and South Carolina.
Call: (833) 666-3115 | Email: info@achievingstarstherapy.com | View all services →