Open Enrollment for ABA Therpy

ABA Insurance Options: What to Consider in Open Enrollment

*Westside Children’s Therapy does not accept Medicaid, but other insurance options are available to get services

Paying for ABA services can be very expensive because of the number of hours most children receive. Without the help of insurance paying the vast majority, it can be difficult to cover it out of pocket. 

Medicaid does cover ABA services in Illinois; however, there is a lack of providers that qualify and accept it. 

The good news is – other options are available. List of Westside’s accepted insurances.

For Affordable Care Act insurance plans, open enrollment runs from November 15th to January 15th. However, you’ll need to sign up by December 15th for coverage to start on January 1st.

During open enrollment consider purchasing a child-only plan. By purchasing a Blue Cross Blue Shield (BCBS) plan through the marketplace during the open enrollment, your child will have access to a far greater network of providers. Having BCBSIL plan for your child will get them coverage for ABA Therapy and all other healthcare services.

Again, the most effective path for a family on Medicaid to receive ABA Therapy for their child with autism is to purchase a private insurance plan during open enrollment for their child. This can be done by connecting with a personal insurance broker, who will help you find an insurance plan that is best for your situation.

(Resources provided below)

In our experience, we have found that the insurance brokers will likely point you to the Blue Cross Blue Shield (BCBS) PPO Bronze Plan. Choosing the Bronze plan to cover a single child, will cost you $303.68 and get you the same services as the other plans, which are more expensive.

It will also leave you with a lower out-of-pocket limit of $7,000.

This flyer is a sample of what resources are available for you to get coverage for ABA while on Medicaid.

For families with low- to moderate income that may struggle to make the out-of-pocket payments and premiums after purchasing the plan, there is assistance for that as well.

Financial assistance Programs for Out-of-Pocket Expenses

Westside has compiled a list of resources that you can use to help with out-of-pocket costs. The Autism Hero Project is an option for getting help with the premiums. 

Another option for families to help with the premium costs is the Health Insurance Premium Payment Program. This is a program that will reimburse the cost of private insurance premiums (purchased through your employer or through the marketplace). In this case, it is likely once you purchase through the marketplace during open enrollment.

It is good to apply to these organizations as soon as possible.

This step MUST come after you purchase the plan to get coverage, as having private insurance is a requirement to be eligible. 

The full list of requirements can be viewed here.

With ABA Therapy, you will almost always meet your plan’s out-of-pocket maximum. 

Westside is here to support you and your child in any way we can, and we have a team that is here to help. You can call (815) 469-1500 to get your questions answered.