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TRICARE ABA therapy coverage

Yes. TRICARE covers ABA through the Autism Care Demonstration when it is clinically necessary and targets the core symptoms of autism. Family members of active duty members, retirees, and some Guard and Reserve members can qualify.

Read the TRICARE policy
A parent on the phone to TRICARE, with the insurance card and a notepad

What the TRICARE policy says

Policy
TRICARE Comprehensive Autism Care Demonstration (ACD) Source: TRICARE (Defense Health Agency).
Coverage
Yes. TRICARE covers ABA through the Autism Care Demonstration when it is clinically necessary and targets the core symptoms of autism. Family members of active duty members, retirees, and some Guard and Reserve members can qualify. Source: TRICARE (Defense Health Agency).
Diagnosis
Your child must be enrolled in a TRICARE plan and have an autism diagnosis from an approved provider, such as a pediatrician, family doctor, psychiatrist, or doctoral-level psychologist. Source: TRICARE (Defense Health Agency).
Prior authorization
Yes. Every TRICARE plan needs a referral to the program and pre-authorization for all ABA services. The diagnosing provider sends the referral to the regional contractor. Source: TRICARE (Defense Health Agency).
Progress reviews
Approvals last six months, and the ABA provider asks for a new approval every six months. Progress forms are done every 6 or 12 months, and a new referral is needed every 24 months. Source: TRICARE (Defense Health Agency).
Hours
TRICARE does not set a fixed number of hours. It pays for ABA that is clinically necessary, with no yearly or lifetime cap. Source: TRICARE (Defense Health Agency).
Who can provide it?
ABA is only offered where board-certified behavior analysts (BCBAs) work. An approved ABA supervisor updates the treatment plan before each new approval period. Source: TRICARE (Defense Health Agency).

ABA is paid under the demonstration, which is separate from the regular TRICARE medical benefit. The program runs through Dec. 31, 2028. You pay one copayment for all ABA on the same day, and four progress forms must be done before ABA starts. Source: TRICARE (Defense Health Agency).

Before the first session, ask TRICARE three things

  1. Is ABA a covered benefit on my plan, and is my plan fully insured or self-funded?
  2. Which ABA providers near me are in network?
  3. What will I pay per session after the deductible, and what is my out-of-pocket maximum?

The member number on your card is all they need. Then use the list for your city and ask each provider whether they're in network with your plan.

ABA therapy providers by city

Other plans: Aetna, Blue Cross and Blue Shield (Excellus BCBS, New York), UnitedHealthcare (Optum Behavioral Health), Cigna, Medicaid by state.