In most cases, yes. Illinois law requires state-regulated health plans to cover ABA therapy for autism for individuals under 21, capped at $36,000/year. Aetna covers ABA therapy when medically necessary, usually with prior authorization. Confirm your specific plan with a Verification of Benefits before starting.
Illinois's autism insurance mandate (215 ILCS 5/356z.15), enacted in 2011, requires coverage for the diagnosis and treatment of autism spectrum disorders — including habilitative/rehabilitative care such as ABA — for individuals under age 21, subject to a maximum annual benefit of $36,000. There's no separate limit on occupational or speech therapy. The mandate applies to individual and group health insurance plans regulated by Illinois. Some guidance suggests certain self-insured plans may also be included in Illinois specifically, which is less common nationally — confirm your plan type directly with Aetna rather than assuming either way. Illinois Medicaid separately covers ABA therapy for the diagnosis and treatment of ASD. Aetna covers ABA therapy for autism spectrum disorder when the plan includes the benefit and treatment is medically necessary.
Most Aetna plans require prior authorization before ABA services begin:
A formal diagnosis based on completed psychological testing showing the individual scored in the autism spectrum disorder range. A school-issued diagnosis alone is generally not sufficient for insurance purposes.
Aetna typically requires a comprehensive treatment plan with measurable goals, assessment results, weekly therapy hours, and the BCBA's credentials.
The process commonly takes 14–30 business days.
Call the member services number on your Aetna card and request a Verification of Benefits. Confirm: ABA coverage, whether the $36,000 annual cap applies to your specific plan, prior authorization requirements, deductible, copay, out-of-pocket maximum.
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This content is for informational purposes only and does not constitute medical, clinical, or therapeutic advice. Consult a licensed healthcare provider or Board Certified Behavior Analyst (BCBA) before making therapy decisions for your child.
Data current as of July 2026. Coverage terms and provider availability change frequently — verify directly with your insurance carrier and the provider before scheduling.