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Is It Covered?

Search the A-Z list for a list of covered services. Your coverage and out-of-pocket costs may vary based on who you are and your health plan option.

Applied Behavior Analysis

TRICARE covers Applied Behavior Analysis (ABA) through a combination of benefits:

  • Basic TRICARE coverage
  • The Extended Care Health Option (ECHO) Autism Demonstration
  • The ABA Pilot

A Federal Register Notice creates the new TRICARE Comprehensive Autism Care Demonstration that will:

  • Replace these three ABA benefits
  • Preserve most of the current rules
  • Cover ABA for all beneficiaries with Autism Spectrum Disorder
  • Be available in the United States and U.S. territories, with some limited availability overseas

TRICARE is now finalizing policy language to implement this program. Details will be announced when the policy is finalized. Requests that meet the criteria will be processed retroactive to the July 25th. You should save any receipts for services covered by this policy.

If your child is getting ABA or related services now:

  • You don’t need to do anything
  • You’ll be moved to the new program automatically
  • There will be no changes to your current treatment plan

Current ABA Coverage

TRICARE covers ABA services for those diagnosed By a TRICARE authorized primary care provider or specialized Autism Spectrum Disorder provider with an Autism Spectrum Disorder. Your basic ABA coverage includes:

  • Functional behavioral assessment and analysis
  • Initial ABA Treatment Plan
  • ABA services
  • Updated ABA Treatment Plan
  • ABA interventions to family member or caregivers

We also cover other care you may need for Autism Spectrum Disorders:

Approved ABA Providers

You can get ABA services through the basic benefit only if your Behavior Analyst is:

  • Board certified, and
  • TRICARE authorized

Note: Board certified Assistant Behavior Analysts aren’t TRICARE authorized.

ABA Reinforcement

Currently, we cover ABA reinforcement through two programs:

Costs for ABA Services

Benefit Costs Caps
Basic TRICARE Coverage Your out-of-pocket costs depend on your TRICARE plan.
  • No annual limit on ABA.
  • You’ll only pay up to your catastrophic cap for all services, including ABA
ECHO Autism Demonstration You’ll pay part of the monthly costs for authorized services, just like other ECHO benefits.  TRICARE pays up to $36,000 annually in cost shares. 
ABA Pilot You pay a 10% cost share.  
  • This doesn’t count toward your TRICARE Standard deductible or your family’s catastrophic cap.
  • TRICARE pays up to $36,000 annually in cost shares.

Last Updated 9/12/2014

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