autism treatment near Johnston | ShineLight Services

Health Insurance for Individuals with Autism in North Carolina

One key factor to research when searching for autism treatment near Johnston is health insurance coverage. Insurance coverage can be difficult to navigate, and often time health insurance companies may try to deny coverage by labeling autism as a developmental issue or identifying therapy as an experimental service rather than a key component in an individual’s autism service plan. Below, we have outlined a variety of health insurance options available for autism treatment near Johnston.

Health Insurance Options for Autism Treatment Near Johnston:

North Carolina State Regulated Insurance Plan

The North Carolina State Regulated Insurance plan ensures that providers offer autism treatment near Johnston and throughout the state. It requires most insurance providers to cover ABA treatment, psychological care, psychiatric care, pharmacy care, and psychological care. There are limits however as ABA is only covered for individuals 19 and under with a $40,000 cap per year.

Self-Funded Health Benefit Plans

Self-funded health benefit plans are regulated by federal law, not state law, which means that they do not have to adhere to state autism plans. Approximately 45% of companies that have more than 500 employees offer ABA treatment, but the rest do not. If your plan does not, start by asking your company if you can choose a different self-funded health benefit plan that does. You can also request a fully insured plan option if it is available.


Medicaid is health insurance that is usually offered based on income level, but in some states, income is disregarded for certain diagnoses including autism. When looking at health insurance for autism, pay special attention to the Early and Periodic Screening, Diagnostic, and Treatment benefit of Medicaid (EPSDT) which applies to all children under the age of 21 and provides for healthcare services that are deemed necessary.

Federal Employees Health Benefits Program

The FEBH provides health insurance to 8.2 million federal employees and their dependents. All FEHB plans must cover ABA for autism treatment in Johnston.


Tricare is the health insurance program provided to U.S. service members and their families. All beneficiaries receive full coverage for ASD.

Marketplace Health Insurance

Unfortunately, health insurance purchased through the North Carolina marketplace does not include autism treatment.

Get Local Aid Navigating Health Insurance

Navigating your health insurance plan and advocating for your right to receive health insurance for autism can be exhausting, but ShineLight can help. We help families look carefully at their health insurance plans so that they can afford autism treatment near Johnston. Contact us today to get help.

About ShineLight | Autism Treatment Near Johnston

ShineLight is a unique organization created with the wellness purpose of providing a brighter life and future for individuals with autism. ShineLight serves as a guiding light for individuals and their families by leading the way in support services and community advocacy. Their service areas include: Fayetteville, Wake, Sampson, Scotland, Duplin, Wayne, Lenoir, Greene, Wilson, Edgecombe, Durham, Johnston, Cumberland, Hoke, Robeson, and Bladen Counties. Contact us today.

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