Avera and Sanford to Offer ABA Therapy Coverage Options in 2020

Oct 11, 2019

Credit State of South Dakota

Sanford Health and Avera Health will now offer health insurance coverage options for Applied Behavioral Analysis (ABA) therapy for 2020.

ABA therapy is considered one of the most effective therapies for children with autism. Without coverage, one year of ABA therapy can cost families up to $100,000.

Deb Muller is the CEO of Avera Health Plan. She explains earlier this year, South Dakota added ABA therapy to its Essential Health Benefits benchmark plan under the Affordable Care Act.

“That definition of having ABA in Essential Health Benefit coverage allows then--or requires then--all carriers that are in the state to allow access in their ACA qualified plans, or ‘Obamacare’ plans,” says Muller.

However, that change doesn’t go into effect until 2021, leaving families without coverage for one year.

Muller says Governor Noem’s office offered to facilitate discussions to find a solution about two months ago.

“You know there’s only so much you can do from a market standpoint," Muller explains, "but it was left to each one of the carriers to make their decision and our decision in the individual market was to resume providing access.”

Both Avera and Sanford Health Plans will offer ABA coverage directly, outside the ACA Marketplace. That means the plans for 2020 are NOT available on the healthcare exchange website.

Open enrollment for 2020 coverage options begins on November first.