What are the Costs of ABA Therapy?
As a general rule, if you have insurance, it likely covers most of your ABA therapy costs. On average, insurance covers 90-95% of the total expenses. Without that level of help, it is difficult to pay for ABA. Therefore, nearly every child we see for ABA has insurance coverage.
While most commercial insurance plans cover ABA therapy costs, there are some self-funded insurance plans that do not. It is common for union healthcare plans to be self-funded. As self-funded plans, they choose whether or not ABA therapy is covered.
Even though insurance generally covers most of the costs, patients still owe out of pocket expenses in the form of deductibles, copays, or coinsurances.
|Deductibles||The amount one must pay on their own before insurance begins covering a portion of medical costs.
|Copays||A daily or per service fee that a minority of insurance plans charge when you come in for therapy (often $20-$50 if your plan has a copay).|
|Coinsurance||After a plan’s deductible is met, insurance plans often cover 70-100% of the ongoing costs. The amount that they do not pay is the coinsurance amount. This is owed by the patient.|
We refer to the total amount paid for any of these costs as “Out of Pocket Costs”. These are dollars paid by you, not your insurance. Most plans set a maximum amount that you would ever pay out of pocket each year for healthcare expenses. This is called an out of pocket maximum amount.
How ABA Therapy Costs Change Throughout the Year
At the start of the year, an insurance plan’s deductibles and out of pocket maximums are not yet met. This is the time of year when insurance plans cover the least amount of costs.
Given that kids receive many hours of ABA each week, both deductibles and out of pockets are met quickly. This usually means costs are briefly high at the start of the year. Shortly after, costs drop to zero when the out of pocket maximum is met.
Cost Example: Typical ABA Patient
Below is an example of weekly ABA therapy costs for a child receiving 20-25 hours of ABA therapy on a plan with a $3,000 out of pocket maximum.
The first week is expensive! In this example, it costs the patient almost $1,500. In the next week, the cost decreases to $375. This signifies the deductible being met and insurance starting to cover their portion.
After week 5, the out of pocket maximum amount is met. This brings the weekly cost for the remainder of the year to $0. In total the patient pays $3,000 for ABA for the entire year. As you can see, ABA costs are very front-loaded at the start of the year.
To smooth out the costs over the year, it is important to ask to be put on a payment plan. Westside offers payment plans that help families pay a consistent amount every week for the entire year. In this example, under a Westside payment plan, the family owes $58 per week, and there is no cost shock at the start of the year.