Insurance
ABA therapy with TRICARE
TRICARE covers ABA therapy for qualifying military families through the Autism Care Demonstration (ACD). We check your benefits for free and walk you through the referral and authorization steps.
Who is eligible
TRICARE covers ABA therapy under the Autism Care Demonstration (ACD) when your child:
- is a qualifying family member of an active duty service member, a retiree, or certain National Guard and Reserve members,
- is enrolled in a TRICARE health plan, and
- has an autism spectrum disorder (ASD) diagnosis from a TRICARE-approved provider.
The diagnosis includes a DSM-5 checklist and the results of a validated assessment tool. Your child’s primary care manager (PCM) or an approved ASD specialist can make the diagnosis.
If the sponsor is on active duty, the family also enrolls in the service branch’s Exceptional Family Member Program (EFMP), and the child enrolls in the Extended Care Health Option (ECHO).
How to start ABA therapy with TRICARE
- Get the diagnosis. Your child’s PCM or an approved ASD diagnosing provider confirms the autism diagnosis.
- Get the referral. The diagnosing provider sends a referral for ABA services to your TRICARE regional contractor. Every TRICARE plan requires this referral and a pre-authorization before ABA starts.
- Assessment. TRICARE’s first authorization covers an ABA assessment. A BCBA meets your child, completes the assessment, and writes a treatment plan with goals for your family.
- Authorization for therapy. The BCBA sends the treatment plan to TRICARE and requests authorization for ABA services.
- Therapy starts. Your child’s ABA sessions begin with the BCBA and the therapy team.
Once services start
The BCBA updates the treatment plan and requests reauthorization every six months. Outcome measures are completed every six or twelve months, depending on the measure, and TRICARE needs a new referral every two years.
TRICARE also assigns an autism service navigator, who builds a care plan with your family and updates it every six months. Families in the US Family Health Plan or living overseas do not get a navigator.
The ACD is authorized through December 31, 2028.
TRICARE families in your community
TRICARE ABA therapy FAQs
Yes. TRICARE covers ABA therapy through the Autism Care Demonstration for qualifying family members of active duty service members, retirees, and certain National Guard and Reserve members. You pay your TRICARE plan's copayment or cost-share, all ABA services on one day count as one copayment, and TRICARE sets no yearly or lifetime cap on the amount of ABA it covers.
Yes. Every TRICARE plan requires a referral to the Autism Care Demonstration and a pre-authorization for all ABA services. The provider who diagnosed your child sends the referral to your TRICARE regional contractor. In the East Region, a specialized diagnosing provider must send the referral if your child is over eight years old.
The first authorization covers an ABA assessment. A BCBA completes the assessment and writes your child's treatment plan, and then requests authorization for ABA services. After that, the provider requests reauthorization every six months.
Yes. If the sponsor is an active duty service member, the sponsor must enroll in their service branch's Exceptional Family Member Program (EFMP), and the child must enroll in the Extended Care Health Option (ECHO).
TRICARE needs a new referral and DSM-5 checklist from your child's ASD diagnosing provider every two years. In between, the ABA provider completes outcome measures every six or twelve months, depending on the measure.
Yes. Our intake team checks your TRICARE benefits for free, tells you what the referral needs to say, and handles the authorization requests once your referral is in.
Sources
- Autism Care Demonstration (TRICARE)
- Applied Behavior Analysis (TRICARE)
- How to Get Started, East Region autism care (TRICARE)
- Steps to Enroll in the ACD, West Region (TRICARE)
Benefit rules change. Your plan documents and your health plan have the final word on your coverage.
Get a free TRICARE insurance check
Tell us about your child and your plan. We check your benefits and explain the next steps, at no cost.
Check My Insurance