Open Enrollment Checklist for Florida Families Who Need ABA (2027 Plans)

Open enrollment is the one time each year most families can change health plans. For a child in ABA, the choice can decide whether therapy is covered, how much you pay, and whether your child can keep the same team. This checklist walks you through the 2027 plan year: key dates, what to compare, the questions to ask, and how to avoid a gap in services when January comes.

When is open enrollment for 2027 plans?

Some plans do not follow the calendar year. If your employer's plan year starts in July, for example, your enrollment window and deductible reset follow that date instead.

The ABA open enrollment checklist

1. Confirm ABA is covered, in writing

• Find "applied behavior analysis" or "autism" in the plan's Summary of Benefits and Coverage or benefit booklet.
• Call the plan and ask: "Does this 2027 plan cover ABA for autism spectrum disorder, CPT codes 97151 through 97158? Is prior authorization required? Are there limits on hours, visits, age or setting?"
• Ask for the answer in writing or note the call reference number.

Do not assume a Marketplace or small-business plan covers ABA. Florida's benchmark plan for 2025 through 2027 has no ABA line, and Florida's autism mandate does not apply to individual or small-employer plans. Some plans include ABA anyway; check each one. See Marketplace plans and ABA.

2. Check whether the employer plan is fully insured or self-funded

If you have a choice of employer plans, or a spouse's plan, ask HR whether each one is fully insured or self-funded. A fully insured plan from a Florida-licensed insurer for an employer with 51 or more employees must cover ABA for eligible children under Florida's Geller Act. A self-funded plan decides for itself. See fully insured vs self-funded plans.

3. Confirm your child's provider is in network for that exact plan

Networks differ between plans from the same insurer. An HMO or EPO may pay nothing out of network. Ask the plan, and ask your ABA provider, whether they are in network for the specific 2027 plan name. See PPO, HMO and EPO networks.

4. Compare total yearly cost, not just the premium

ABA means many claims, so the out-of-pocket maximum often matters more than the premium. For each plan, write down:

• the monthly premium times 12;
• the deductible (individual and family);
• the copay or coinsurance for ABA;
• the in-network out-of-pocket maximum.

For a child with many approved hours, a rough worst case is the yearly premium plus the out-of-pocket maximum. For 2027, HealthCare.gov lists the Marketplace limit as "No more than $12,000 for an individual or $24,000 for a family." Employer plans set their own maximums. Our deductible math guide shows how to compare plans with real examples.

5. Plan for the January deductible reset

Most plans reset deductibles and out-of-pocket totals on January 1. If you met your maximum in 2026, your costs start over in January. Budget for higher costs early in the year, and ask your provider about a payment plan or sliding scale if needed.

6. Ask about authorizations if you switch plans

A new plan, or even a new insurer, usually means a new prior authorization. The new plan may want a fresh assessment or recent progress data. Ask:

• "Will the new plan accept my child's current treatment plan, or need a new assessment?"
• "Does the new plan offer a transition or continuity-of-care period?"
• "How long do ABA prior authorizations usually take?"

Tell your provider about a plan change as early as you can, ideally before December, so the paperwork can start right when the new plan becomes active.

7. Check HSA and FSA choices

If your employer offers a flexible spending account, ABA copays and coinsurance are generally qualified medical expenses. If you pick a high-deductible plan with an HSA, remember that ABA is not preventive care, so you pay the deductible first. See using an HSA or FSA.

8. Consider two plans

If your child is eligible for two plans, for example through both parents, the second plan can sometimes pick up costs the first leaves behind. Coordination of benefits rules decide which pays first. See two plans and ABA.

Which questions should I ask HR or the plan?

1. Is the plan fully insured or self-funded, and in which state was it issued?
2. Does it cover ABA for autism, and is there an age, hour or setting limit?
3. Is prior authorization needed, and who reviews ABA requests?
4. Is my child's ABA provider in network for this exact plan?
5. What are the deductible, ABA cost-sharing and out-of-pocket maximum?
6. Does the plan year follow the calendar year?
7. Is anything about the plan changing for 2027, such as the administrator or network?

What if I miss open enrollment?

Outside open enrollment, you can usually change plans only after a qualifying life event, such as losing other coverage, a move, marriage, or a birth or adoption. HealthCare.gov explains special enrollment periods. Employer plans have their own rules; federal rules give at least 30 days after most events, and 60 days after losing Medicaid or CHIP. If your current plan does not cover ABA and you cannot switch, ask your employer about adding ABA at the next renewal, and ask providers about self-pay options in the meantime.

How Hope Center can help during open enrollment

Before you choose, Hope Center for Behavior Change can run a free benefits check on the plans you are considering, if you have the plan details, and tell you whether we are in network. We work with Blue Cross Blue Shield (Florida Blue), Aetna, Cigna (Evernorth), UMR, Personify Health and TRICARE East (Humana Military). Your costs depend on your plan, and we offer self-pay with a sliding scale. Visit insurance at Hope Center, request a free benefits check or call 561-337-8865.