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 a new demonstration program that will replace these benefits.
The new Autism Care Demonstration will:
- Preserve most of the current rules
- Cover ABA and related services for those with an Autism Spectrum Disorder diagnosis
- 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
You’ll see some key changes with the new program:
- No annual or lifetime cap
- Same level of coverage for all beneficiaries
- Easier to track progress
- Simpler testing requirements
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.
Currently, we cover ABA reinforcement through two programs:
Costs for ABA Services
|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.
||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.