Looking for the best insurance for autism, ADHD, and other neurodivergent kids?
In 2014, JAMA reported between $1.4 – 2.2 million in lifetime expenses associated with support for autistic individuals. A bulk of this is for educational support that could be buffered by proper interventions.
Parents like you and me are strapped for cash and pulled in every direction to provide for the children we love.
So, today, we’re talking about how to mitigate medical expenses by choosing the best insurance options for autism.
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Family Healthcare Costs Related to Autism
Every November, open enrollment begins and parents must decide which healthcare plan to choose.
Healthcare costs for American families like ours are driven by various factors.
- insurance premiums,
- prescription drug prices,
- facility fees, and
- physician charges
Insurance companies claim they face rising costs when negotiating contracts with pharmaceutical companies or hospitals.
This means that we consumers bear much of the burden when our insurance provider increases premiums and deductibles.
So choosing the right comprehensive medical coverage for our families is essential. When one or more family members are autistic, have ADHD, or have other support needs, we need to be strategic.
In other words, it’s vital to get health care coverage that suits your family’s particular needs.
Affordable Care Act and Autism
The Affordable Care Act is a government program that seeks to ensure insurance coverage for all eligible individuals in the United States.
You’re eligible to get insurance through the ACA marketplace if you:
- are a US citizen
- live in the United States
- aren’t incarcerated
Additionally, if you use Medicaid, you are not eligible for ACA Marketplace health care.
Regardless of your politics, it’s important to know how ACA impacts your individual health benefit plans. Specifically, how it protects you, your autistic child, or anyone with developmental disorders.
Due to this federal law, insurance companies have autism coverage guidelines from which to operate.
ACA Insurance Guidelines for Autism
Regardless of whether or not your family uses ACA insurance, insurance companies must adhere to certain guidelines.
- Prohibited from increases in premiums based on an autism diagnosis
- Must provide preventative care and screening for autism
- Health insurers cannot implement a maximum benefit for autism coverage
- Autism benefit coverage has no dollar limits
- No cap on the number of visits for medically necessary treatments
- Age limits have increased meaning that young adults can remain on their parent’s insurance until 26 years of age
Further, health insurance coverage must include essential health benefits. Each state has its own autism laws, so check out your state’s autism insurance laws.
Autism and Essential Health Benefits
What are the autism-related essential health benefits that must be covered in all insurance plans?
- preventative care
- emergency services
- mental health
- rehabilitative and habilitative services and devices
- hospitalizations
- prescription medications
- laboratory services
- vision and dental care
Specific to caring for autism, most parents will want to maximize the use of the following health benefits.
Essential Services Coverage for Autism
There are specific healthcare services that are essential for the long-term well-being of any autistic individual.
- Occupational therapy
- Speech therapy
- Physical therapy
- Mental health support
First, we’ll discuss occupational therapy, physical therapy, and speech therapy as critical autism-related services to look for in any health plan.
Each of these support services can contribute to the overall well-being of your autistic child. For example, they can:
- support a child’s life skills for future independence
- developmental areas including speech, motor skills, educational, and cognitive functioning
- recovery and habilitation from an injury or illness
Now let’s dive into each one of these services that you’ll want to look for in health insurance plans.
Occupational Therapist (OT)
Occupational therapists work with kids and adults of all ages. However, when you’re considering an OT for your child, you’ll want to look for a pediatric OT with expertise in autism.
Again, each person will have different needs. However, an OT can support kids who, due to physical, developmental, social, or emotional challenges, may be limited in their ability to perform tasks needed for daily living.
Private occupational therapists are specialized service providers who can help kids…
- develop better coordination and strength,
- improve decision-making skills,
- improve sensory processing challenges,
- integrate primitive reflexes,
- enhance self-esteem,
- improve emotional regulation and behavior,
- increase independence.
In the end, occupational therapy is an essential part of autism treatment.
Choose the Right PRIVATE OT
However, there are two important caveats to know.
- Occupational therapy provided by a school system is NOT the same as private OT.
- In a school system, OTs are limited by red tape and rules that limit their ability to address underlying issues.
- A good occupational therapist will:
- support your child’s specific needs,
- listen to and consider your input,
- and work with you to create a targeted treatment plan
You’re the CEO of your child’s team.
Speech-Language Therapy (ST)
Speech therapy is another form of treatment especially beneficial for autism. This is because autistic children have extremely high rates of speech and language challenges.
Speech therapy is designed to help children with communication, language, and speech disorders.
Private speech therapists use strategies based on your child’s specific needs.
Again, a good speech-language pathologist (SLP) will be a part of your child’s team. As such, they should partner with you to determine your child’s speech and language goals.
Some areas ST can help your child include the following.
- language intervention activities,
- articulation therapy,
- social communication skills,
- reading skills, and
- other language-based learning challenges such as dyslexia
With proper diagnosis, the therapist can identify areas where your child is struggling and develop a plan to address their issues.
If you suspect a speech delay or disorder such as apraxia of speech, early intervention makes a huge difference.
Physical Therapy (PT)
Physical therapists are highly-trained professionals who assess the different needs of their patients related to helping the body move.
Further, they develop individualized treatment programs depending on your child’s needs.
Physical therapists can help with early childhood developmental delays often seen in autism. For example, PTs can help infants and toddlers with delayed milestones such as:
- sitting
- crawling
- walking
In older autistic or neurodivergent children, a physical therapist can provide therapeutic care related to learning to ride a bicycle.
Types of PT Strategies
Additionally, physical therapists can help autistic children improve their overall motor skills through a variety of movements.
Some include:
- stretching exercises,
- postural correction techniques,
- massage therapies,
- or manual manipulation.
In the end, physical therapists use a form of medical treatment that helps kids improve their physical function, quality of life, and mobility.
Mental Health Coverage is a MUST-HAVE for Autism
Mental health treatment is essential for the long-term well-being of any child. However, for those in the autistic community, it’s a non-negotiable.
Note that sometimes “mental health treatment” is referred to as “behavioral health treatment“.
Behavioral health treatment refers to mental health. These treatment specialties may include:
- marriage and family therapy,
- psychological care,
- psychoeducational testing,
- psychiatric care,
- counseling,
- and addiction treatment.
Mental health support is CRITICAL for autistic and other neurodivergent children and adults.
Autistic children and adults suffer high rates of co-occurring mental health conditions including high rates of depression, anxiety, and more.
Behavioral Health is Not ABA
Please do not confuse the term behavioral health with the controversial applied behavioral analysis (ABA services).
Autism’s Mental Health Crisis
According to a 2019 meta-analysis of rates of depression and anxiety in the autistic community,
Compared to typically developing individuals, individuals with ASD are 4-times more likely to experience depression in their lifetime. These results suggest that individuals with ASD should be regularly screened and offered treatment for depression.
Hudson, C.C., Hall, L. & Harkness, K.L., Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis
Why are these children suffering so much?
Well, the rates at which autistic children are bullied are alarming. And sadly, bullying is not limited to peer-to-peer bullying.
Autistic children are often bullied by the adults charged with caring for them as teacher bullying is happening in every school district across the country.
Additionally, as many in the autistic community point out, ABA therapy has led to PTSD in more than half of the autistic population.
Protect your autistic loved ones and look for the best mental health coverage in your chosen insurance plan.
Shop Around
Know that your child can benefit from having access to multiple mental health services.
As with autism, quality of care is on a spectrum and will vary based on the specific mental health professional you work with. Don’t be afraid to shop around and seek out therapists recommended by those in the neurodiversity and special needs community.
Some mental health support members for your autistic child’s team include:
- Licensed psychologist,
- Clinical social worker,
- Marriage and Family Therapists,
- Cognitive Behavioral Therapists
In the end, it’s important to look for a strengths-based support team for your child. I recommend looking for specialists with expertise in trauma-informed care such as EMDR, polyvagal theory, and neurodiversity.
If an autism services provider does not value you and your child’s input, fire them.
The good news is that with the right individual plan, you should be able to find a quality in-network provider of mental health care.
On the other hand, due to the red tape of the current medical system, many high-quality professionals have left insurance companies altogether. As such, they’re private pay.
If your preferred provider is independent, you may want to consider a high-deductible plan that leaves more room in your pocket for out-of-network providers.
Psychiatric Care & Prescription Coverage
According to a 2021 report,
Autistic children with unmet need for mental health care were less likely to participate in their community than children who had no unmet need for mental health care.
An important part of your child’s mental health care may include medications to help them with ADHD, anxiety, or depression.
And this is where access to an in-network quality psychiatrist can be of value.
Further, having the necessary pharmacy care coverage will allow a quality psychiatrist or licensed physician to prescribe much-needed medications.
Choosing an HDHP vs. HMO for Autism
Deciding whether to choose a High-Deductible Health Plan or a traditional HMO plan is one worth considering.
High-Deductible Plans
The primary benefit of a High Deductible Plan (HDHP) is lower premiums and access to preferred providers that may not be in-network.
Additionally, since consumers take on more of their medical expenses, the monthly premium associated with an HDHP is usually much lower than other plans.
High deductible plans allow you to save on monthly premiums while providing access to basic care such as doctor visits, prescription drugs, and specialist services.
Additionally, with a high-deductible plan, extra money in your pocket allows you to seek alternative treatments that can be valuable for neurodivergent kids and adults.
On the other hand, the high-deductible amount can be daunting and needs to be accounted for in your monthly budget.
In our home, we opt for the high-deductible plan as it gives us greater control over our healthcare spending dollars and treatment.
Health-Maintenance Organization (HMO) Plans
On the other hand, with the rising costs of healthcare, many people consider using a Health Maintenance Organization (HMO) as a way to reduce their monthly expenses.
One discerning factor is that HMOs tend to provide more comprehensive coverage with fewer out-of-pocket costs, but higher monthly premiums.
Additionally, there are more rules regarding preauthorization. Moreover, you’ll have less control over the healthcare professionals you want working with your child.
Like any form of insurance coverage, there are both positives and negatives to take into account for either option.
Alternative Autism Therapy Options
These therapies provide an alternative to traditional treatments, offering creative, and engaging ways of managing physical illness, learning, and mental health issues.
Animal Assisted Therapy
Animal Assisted Therapy (AAT) is a form of therapy that utilizes the presence of animals as part of the healing process.
It has been used to help treat kids with physical and mental health issues, including depression and PTSD.
Benefits of Equine Therapy:
- improved balance
- (an essential aspect of language production, emotional regulation, and overall motor skills)
- improved spasticity
- tightening of muscles
- can lead to decreased motor movement related to walking and speech
- tightening of muscles
AAT works by creating a comforting atmosphere for children who may have difficulty engaging in traditional therapy.
Chiropractic Care
Chiropractic care is focused on treating musculoskeletal problems. It may include spinal manipulation, massage therapy, and posture exercises.
Insurance companies are well aware that chiropractic care is an effective form of treatment for back pain, headaches, and other musculoskeletal issues.
As the popularity of chiropractic treatment grows, many insurance plans are providing coverage for these services.
According to Dr. Nick Niday, DC,
Chiropractic is a great option because it has been known to reduce the sympathetic tone (fight or flight) and “relax” the nervous system .
Benefits of Chiropractic Care for Autism:
- calms the sympathetic nervous system
- improves sleep
- supports digestion
Some insurance plans will pay for all or part of the cost associated with your child’s chiropractic visits, while others may limit coverage to specific types of treatments or injuries.
Generally speaking, chiropractic care should cover:
- assessments,
- therapeutic exercises,
- manual therapy techniques such as mobilization or soft tissue manipulation,
- x-rays if necessary,
- and other medically necessary services
Again, the amount of chiropractic care covered will depend on the type of plan purchased. However, most policies provide some form of coverage for chiropractic services.
Art Therapy
Art therapy is a form of treatment that uses art and creative activities to help kids explore their emotions, develop life skills, and resolve conflicts.
This type of therapy has been used for decades as a way to nonverbally express one’s thoughts, feelings, and behaviors.
Art therapy is an incredible way to support your child’s overall well-being and emotional regulation.
Music Therapy
Music therapy can reduce stress, anxiety, and depression levels in children.
It provides relief from pain as well as helps with communication difficulties or learning disabilities.
Music also plays a role in helping kids recover memory or motor skills after suffering brain injury or stroke.
According to a 2018 study, music activates the area of the motor cortex (the area of the brain responsible for movements including walking, writing, and speaking.)
Misc. Insurance Coverage
Depending on your needs, some insurance plans provide benefits for both inpatient and outpatient care.
Additionally, they may mitigate the costs of:
- prosthetic devices,
- orthotics,
- educational classes,
- durable medical equipment,
- home healthcare-related expenses
- and more.
If these considerations impact your family, look for them in possible insurance plans.
The Pros and Cons of Health Insurance
As with any type of insurance, there are pros and cons to be aware of when deciding to invest in a health insurance policy.
Medical coverage or health insurance is an important aspect of modern life and is essential for neurodivergent children.
- Autism
- ADHD
- Dyslexia
- Intellectual Disability
- other Developmental disabilities
It can provide security and assurance that any medical expenses incurred will be covered.
Pros of Insurance
Medical insurance helps cover the cost of necessary and preventative health care services including:
- regular check-ups
- and screenings
Having access to quality healthcare can be beneficial for all family members, especially those with pre-existing conditions or chronic illnesses.
Additionally, medical insurance can help cover expenses related to catastrophic or unforeseen illnesses or injury occurs.
Cons of Insurance
Medical insurance often comes with high premiums and deductibles that can be difficult for families to pay.
Additionally, many policies come with exclusions or restrictions on what they will cover. For example, most policies do not cover all beneficial treatments.
- art therapy
- equine therapy
- MNRI therapy
Additionally, many families find that in-network doctors are pressured to prescribe medications based on insurance coverage rather than what’s best for the patient.
When you choose out-of-network providers, you pay more, but often get better care in the long run.
Considerations When Choosing Insurance for Autism
Again, getting insurance coverage designed to meet your family’s needs is essential.
Fortunately, there has been increased awareness surrounding mental health issues and more focus on providing better coverage options.
So, now that you know about treatment options that can support your autistic family members, here are some specific questions to consider when choosing.
First, start by researching the type of plan you want to buy or sign up for.
- What treatments are covered?
- How much coverage do you get?
- Do you need prior authorization?
- What is your co-pay?
- How often do you need to take your child to the doctor?
- What prescriptions do you need each month?
- Which providers are in-network?
- How much is the deductible?
- What, if any, alternative treatment options are covered?
Look at the fine print and see if these are available for your autistic child or yourself.
Misc. FAQs: Best Insurance for Autism
Group health insurance plans are provided by larger corporations for their employees. Two types of these plans are Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). These healthcare plans are typically private insurance companies not run by the federal government.
Like the autism spectrum itself, every autistic child is unique and has their own needs. However, in general, the best treatment and support options for autism are the following. Strengths-based occupational therapy, speech therapy, and mental health therapy.
No. I cannot in good conscience recommend ABA therapy. The larger autistic community has made it very clear that ABA therapy, rooted in behaviorism, seeks to change behavior without supporting the internal experience of the person. The rates of PTSD in autistic adults who grew up receiving ABA training are devastating. If the goal is long-term well-being, we must consider the voices of those with lived experience.
If any expert tells you that one way is the only way to support your child, there’s a problem. At a minimum, please make an informed decision that considers the experiences of autistic people. In the end, knowing all of your therapy options to best support your autistic child is essential.
Technically, all 50 states require insurance plans to cover testing, diagnosis, and screenings for autism. However, each state has different requirements for coverage related to supports for Autism.
Many insurance companies claim they’ll only cover Applied Behavioral Analysis therapy because it’s “evidenced based.” Please understand that this type of therapy is considered extremely controversial and the evidence does not take into account the mental health of the child. Speech, OT, PT, and other services will be covered when the billing department uses proper insurance codes specific to the area of needs addressed (ie. mixed-receptive expressive speech delay, for example).
Recap: Best Insurance for Autism & Neurodivergent Kids
Getting the right medical insurance is essential when caring for your autistic family members. As your child’s parent, it’s important that you’re informed on what options are available to allow your child to thrive.
This is why A Heart for All Students exists. Together, one mom at a time, we can change the narrative for neurodivergent kids.
You’ve got options for your child’s treatment, healthcare, and educational needs.
You’re in charge momma and can be the CEO of your child’s support team.
So, what do you think? In this with you!
About the Author:
Lindsay is a trauma-informed educator with a Master’s Degree in Teaching. Her mission is to support moms to equip neurodivergent kids (ADHD, Autism, Dyslexia, Anxiety) to thrive as exactly who they’ve been created to be. Wait until you hear the story that led to it all…
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