Does Medicare Cover Autism?

Medicare Bob
Medicare General Info
People with ASD are at a higher risk of developing some serious health conditions. Learn how your Medicare plan can help cover autism services.
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Autism Speaks estimates that about 50,000 adolescents with autism become adults every year. Adults with Autism Spectrum Disorder (ASD) are at higher risk of developing chronic health conditions, like diabetes, immune conditions, obesity, depression and other psychiatric disorders.

ASD is a chronic condition with a wide range of symptoms and varying levels of impairment that can look different for every individual. It can occur across all racial and socioeconomic groups, but ASD is more than four times more prevalent in males than females. 

According to the Centers for Disease Control and Prevention (CDC), caring for a child with ASD can cost an additional $4,000 to $6,000 per year. For Americans on the autism spectrum, Medicare does offer some coverage. 

No matter where you live within the 50 states, Medicare can cover medically necessary developmental and behavioral health treatment services for themselves and their beneficiaries diagnosed with ASD.

How Can Medicare Help Pay for ASD Services?

In January 2014, the Centers for Medicare & Medicaid Services (CMS) released a report providing in-depth information about services and support available to those with ASD. Because Medicare coverage and requirements for services related to an ASD diagnosis can vary, it’s important to read through this report, which offers state-by-state coverage information. 

In general, if you have Medicare Part B, you can receive coverage for chronic care management services, which includes autism spectrum disorders. 

Medicare can also cover applied behavior analysis (ABA) — a type of therapy considered effective in treating ASD — when a physician deems it medically necessary. 

If you have a child over the age of 20 who has ASD, they could qualify for Medicare after they’ve received Social Security Disability Insurance (SSDI) for at least two full years. 

If you have questions about autism, call the Autism Society National Helpline at 1-800-3-AUTISM (328-8476), or fill out the form on its website for someone to contact you.

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.

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