ABA Therapy & Marketplace Health Insurance: What You Need to Know

Aug 25 2025 20:47

Robert Routt

 

ABA Therapy & Marketplace Health Insurance: What You Need to Know

Applied Behavior Analysis (ABA) is a cornerstone therapy for children with autism, helping them gain critical skills in communication, social interaction, and daily functioning. But does the ACA Marketplace guarantee coverage for ABA? Unfortunately, the answer depends on where you live.

What Are “Essential Health Benefits”?

Under the Affordable Care Act (ACA), all health plans sold through the Marketplace must include 10 essential health benefits, such as:

  • Mental health and substance use treatment

  • Rehabilitative and habilitative services (which can include ABA therapy, depending on the state)

  • Pediatric services, prescription drugs, and more ( HealthCare.gov , Verywell Health , Wikipedia )

These serve as baseline requirements—but specifics vary by state.

ABA Coverage by State

Currently, only 33 states plus Washington, D.C. require Marketplace (and comparable off‑Marketplace) plans to cover ABA therapy:

Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, South Dakota, Tennessee, Texas, Vermont, Washington, West Virginia, Wisconsin, and Wyoming( Autism Speaks )

 

In these states, ABA coverage is mandatory for non-grandfathered individual and small-group plans—even outside the Marketplace.

What About Florida?

Florida is not among the states that require ABA coverage in ACA Marketplace plans. That means:

  • Marketplace plans in Florida are not required to include ABA therapy as part of essential health benefits ( Autism Speaks , Magnolia Behavior Therapy ).

  • Coverage is optional and determined by individual insurers—many plans may not include ABA.

  • Families in Florida often have better success with ABA coverage through Florida KidCare (CHIP) or specific employer plans governed by Florida’s autism insurance mandate ( Magnolia Behavior Therapy , Autism Speaks ).

What’s Next for Families in Florida?

If you're seeking ABA coverage in Florida, here’s what you can do:

  1. Review Marketplace plans carefully —look for benefits labeled “habilitative services” or mention of autism-specific care.

  2. Ask carriers directly:

    • “Does this plan include ABA therapy?”

    • “Are there age or dollar caps?”

    • “What in-network providers are available?”

  3. Explore alternative options, especially if ABA is a critical need:

    • Florida KidCare (CHIP) often covers ABA for eligible children.

    • Employer-sponsored plans may offer coverage if governed by Florida’s mandate.

Why It Matters

Without mandatory ABA coverage in state EHB packages, Florida families can face uncertainty—and potentially missed opportunities for vital treatment. The good news? Knowing your options and asking the right questions makes a big difference.

In Summary

  • ACA Marketplace plans must cover essential benefits, including mental and behavioral health—but specifics like ABA therapy depend on state laws.

  • 33 states and D.C. mandate ABA coverage in Marketplace plans; Florida is not one of them.

  • For families in Florida, ABA coverage may still be possible—but you’ll need to check plan-by-plan or explore KidCare/Medicaid alternatives.

Autism Speaks continues to advocate for equitable access to ABA therapy nationwide—working with policymakers, families, and providers to make care more consistent and available for every child. Let me know if you'd like help evaluating specific Marketplace plan summaries or connecting with KidCare resources!