Autism Insurance Coverage in Texas: What Parents Need to Know About Therapy Costs

Understanding Autism Insurance Coverage & Therapy Costs

Parents, did you know that autism insurance coverage can make or break your family's therapy budget? Autism therapy can cost up to $130,000 a year. Between speech therapy, occupational therapy, physical therapy, and ABA therapy, the price tag can be overwhelming. Even with insurance, navigating deductibles, coinsurance, and max out-of-pocket costs can feel like a nightmare.

In this guide, I’ll break everything down step-by-step so you can plan your budget and avoid unexpected bills.

Why Autism Insurance Coverage Matters for Families

I’m Sergio Rodriguez, an occupational therapist, and together with my wife, a speech therapist, we run a private practice in San Antonio, Texas. We work with autistic children daily, and one of the most common questions we get is: “How much will I actually pay out of pocket for my child’s therapy?”

Let’s make this simple. I’ll cover:

1. The top 3 things you need to know about your insurance plan

2. The real costs of autism therapies before insurance

3. Real-life scenarios showing what families typically pay after insurance

   
   

The 3 Key Insurance Terms Parents Must Understand

Think of your insurance plan like a video game with three levels you need to unlock.

Level 1: Deductible

At this level, you’re paying 100% out of pocket until you hit your deductible.

• Example: A $4,000 deductible means you cover every therapy and doctor’s visit until you reach that $4,000.

• Note: Your monthly premium does NOT count toward your deductible.

Level 2: Copay or Coinsurance

Once your deductible is met, you unlock cost-sharing:

• Copay: Fixed fee per visit (e.g., $30 per therapy session)

• Coinsurance: A percentage of the session cost (e.g., 20% of a $100 session = $20)

Level 3: Max Out-of-Pocket (MOOP)

MOOP is the most you will pay in a year before insurance covers 100% of all costs.

• Includes your deductible + all copays or coinsurance

• Example: MOOP = $8,000, after which therapy is fully covered

  
  

  

  
  

Is Insurance Worth It for Autism Therapy?

Some families wonder, “If I’m paying $8,000 out of pocket, is autism insurance coverage even worth it?”

For many of the families I work with, the answer is yes. If your child needs multiple therapies, doctor visits, or surgery, you may hit your MOOP faster than you think.

Real Autism Therapy Costs (Before Insurance)

Keep in mind, rates vary by state and provider.

Speech Therapy

• Evaluation: $140

• Sessions: $60 per 30-minute session

• 1-2 sessions/week: $240 - $480/month

Occupational Therapy

• Evaluation: $150

• Sessions: $110 per session (1 hour)

• 1-2 sessions/week: $440 - $880/month

Physical Therapy

• Evaluation: $150

• Sessions: $110 per session (1 hour)

• 1-2 sessions/week: $440 - $880/month

ABA Therapy (Applied Behavior Analysis)

• Evaluation: $600

• Sessions: $50/hour

• 20-40 hours/week: $4,000 - $8,000/month

  
  

What Will YOU Pay? Real-Life Insurance Scenarios

Scenario 1: ABA Therapy Only (20 hours/week)

• Before deductible: $4,000/month = $48,000/year

• With 20% coinsurance: $800/month (until MOOP)

Scenario 2: Speech & Occupational Therapy (1 session/week each)

• Before deductible: $680/month = $8,160/year

• With 20% coinsurance: $136/month (until MOOP)

• With $30 copay: $240/month (until MOOP)

Scenario 3: ABA, Speech, OT & PT Combined

• Before deductible: $5,120/month = $61,440/year

• With 20% coinsurance: $1,024/month (until MOOP)

• With $30 copay: $2,760/month (until MOOP)

  
  

  

  
  

How Fast Will You Reach MOOP?

Scenario 1 (ABA Only):

• Deductible reached in 1 month

• MOOP reached in 6 months

Scenario 2 (Speech & OT):

• Deductible reached in ~6 months

• MOOP not reached within the year

Scenario 3 (All Therapies):

• Deductible reached in ~3 weeks

• MOOP reached in under 5 months

  
  

Final Thoughts: Choose the Right Therapy for Your Child

You don’t need to stack every therapy to hit your MOOP fast—focus on what’s most essential for your child.

Talk to your healthcare provider or therapy team to create a care plan that fits your goals and your budget.

Need help? Reach out to me at sergio@pediatricconstellations.com - I would love to help!