{"id":46926,"date":"2026-11-02T14:30:27","date_gmt":"2026-11-02T14:30:27","guid":{"rendered":"https:\/\/bluegemsaba.com\/?p=46926"},"modified":"2026-11-02T14:32:52","modified_gmt":"2026-11-02T14:32:52","slug":"aba-therapy-deductibles-copays-coinsurance","status":"publish","type":"post","link":"https:\/\/bluegemsaba.com\/es\/aba-therapy-deductibles-copays-coinsurance\/","title":{"rendered":"Descuentos en la terapia ABA, copagos y coaseguros: \u00bfQu\u00e9 pagan realmente los padres?"},"content":{"rendered":"<p class=\"wp-block-paragraph\">\u201c<a href=\"https:\/\/bluegemsaba.com\/es\/insurance-aba-therapy\/\" style=\"text-decoration:underline;\">Su seguro cubre la terapia ABA<\/a>\u201dEs una buena noticia y a\u00fan as\u00ed muchos padres se preguntan cu\u00e1nto tendr\u00e1n que pagar.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La cobertura significa que tu plan pagar\u00e1 la terapia de an\u00e1lisis de comportamiento aplicado (ABA) de acuerdo con sus normas. Estas normas suelen dejar parte de la factura a tu cargo, mediante un porcentaje deducible, copagos o cofinanciaci\u00f3n.<sup><a href=\"#ref-1\" style=\"text-decoration:underline;\">1<\/a><\/sup><sup><a href=\"#ref-2\" style=\"text-decoration:underline;\">2<\/a><\/sup><sup><a href=\"#ref-3\" style=\"text-decoration:underline;\">3<\/a><\/sup><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"600\" height=\"375\" src=\"https:\/\/bluegemsaba.com\/wp-content\/uploads\/2026\/11\/ABA-Therapy-Deductibles-Copays-and-Coinsurance-Quote-Image.png\" alt=\"Blue Gems ABA quote explaining how insurance costs affect ABA therapy planning\" class=\"wp-image-46927\" srcset=\"https:\/\/bluegemsaba.com\/wp-content\/uploads\/2026\/11\/ABA-Therapy-Deductibles-Copays-and-Coinsurance-Quote-Image.png 600w, https:\/\/bluegemsaba.com\/wp-content\/uploads\/2026\/11\/ABA-Therapy-Deductibles-Copays-and-Coinsurance-Quote-Image-300x188.png 300w, https:\/\/bluegemsaba.com\/wp-content\/uploads\/2026\/11\/ABA-Therapy-Deductibles-Copays-and-Coinsurance-Quote-Image-18x11.png 18w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\">Los t\u00e9rminos pueden ser confusos, pero la terapia ABA los hace m\u00e1s importantes que de costumbre. Un ni\u00f1o con trastorno del espectro autista (TEA) puede necesitar varias sesiones cada semana, por lo que las peque\u00f1as cantidades por visita se acumulan durante un a\u00f1o.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En este art\u00edculo, hablaremos sobre lo que significan los deducibles, los copagos y la coparticipaci\u00f3n en los costos en el tratamiento ABA y c\u00f3mo estimar cu\u00e1nto pagar\u00e1 su familia.<\/p>\n\n\n\n<div style=\"border-left:4px solid #0f2c5a;background:#f4f7fb;padding:20px 24px;border-radius:8px;margin:24px 0;\">\n<h2 style=\"color:#0f2c5a;font-size:24px;margin:0 0 12px;\">Principales conclusiones<\/h2>\n<ul style=\"margin:0;padding-left:22px;line-height:1.7;\">\n<li>Los deducibles, los copagos y la co-seguro determinan cu\u00e1nto pagan las familias por la terapia ABA cubierta.<\/li>\n<li>Las sesiones de terapia frecuentes pueden provocar que los gastos personales se acumulen r\u00e1pidamente.<\/li>\n<li>Una vez que llegue al m\u00e1ximo permitido por su plan, los cuidados cubiertos dentro del sistema de salud del plan en general no costar\u00e1n nada m\u00e1s durante el resto del a\u00f1o del plan.<\/li>\n<li>Comprobar las redes de proveedores, la elegibilidad para el Medicaid y los l\u00edmites anuales del plan pueden ayudar a las familias a planificar sus gastos.<\/li>\n<\/ul>\n<\/div>\n\n\n\n<h2 id=\"h-what-do-deductible-copay-and-coinsurance-mean-for-aba-therapy\" class=\"wp-block-heading\">\u00bfQu\u00e9 significan la deducci\u00f3n, la copagosidad y la coaseguro en la terapia ABA?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Cada t\u00e9rmino describe una forma diferente en la que tu plan de salud comparte los costos contigo. La mayor\u00eda de los planes combinan un monto deducible con copagos o co-seguro.<sup><a href=\"#ref-1\" style=\"text-decoration:underline;\">1<\/a><\/sup><sup><a href=\"#ref-2\" style=\"text-decoration:underline;\">2<\/a><\/sup><sup><a href=\"#ref-3\" style=\"text-decoration:underline;\">3<\/a><\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La coseguro se basa en la tasa que su plan ha acordado pagar a un proveedor de la red de salud, denominada monto permitido.<sup><a href=\"#ref-4\" style=\"text-decoration:underline;\">4<\/a><\/sup> Esta tarifa suele ser m\u00e1s baja que la que un proveedor cobrar\u00eda a una familia que pague <a href=\"https:\/\/bluegemsaba.com\/es\/how-much-is-1-hour-of-aba-therapy\/\" style=\"text-decoration:underline;\">Por hora sin seguro<\/a>.<\/p>\n\n\n\n<div style=\"max-width:100%;overflow-x:auto;margin:24px 0;border-radius:10px;border:1px solid #dce3ec;\">\n<table style=\"width:100%;border-collapse:collapse;font-size:15px;line-height:1.6;table-layout:auto;\">\n<thead>\n<tr style=\"background:#0f2c5a;color:#ffffff;\">\n<th scope=\"col\" style=\"background:#0f2c5a;color:#ffffff;padding:14px;text-align:left;vertical-align:top;white-space:normal;\">Plazo de vigencia de la p\u00f3liza de seguro<\/th>\n<th scope=\"col\" style=\"background:#0f2c5a;color:#ffffff;padding:14px;text-align:left;vertical-align:top;white-space:normal;\">Lo que pagas<\/th>\n<th scope=\"col\" style=\"background:#0f2c5a;color:#ffffff;padding:14px;text-align:left;vertical-align:top;white-space:normal;\">Ejemplo<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"background:#ffffff;\">\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\"><strong>Deducible<\/strong><\/td>\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\">Gastos iniciales cubiertos antes de que tu plan comience a compartir ciertos gastos<\/td>\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\">Los primeros $2.000<\/td>\n<\/tr>\n<tr style=\"background:#f4f7fb;\">\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\"><strong>Copay<\/strong><\/td>\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\">Importe fijo para un servicio cubierto<\/td>\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\">$25 por d\u00eda de sesi\u00f3n<\/td>\n<\/tr>\n<tr style=\"background:#ffffff;\">\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\"><strong>Coaseguro<\/strong><\/td>\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\">Porcentaje del monto permitido<\/td>\n<td style=\"padding:13px;border-bottom:1px solid #e1e7ef;vertical-align:top;\">20% de $100 = $20<\/td>\n<\/tr>\n<tr style=\"background:#f4f7fb;\">\n<td style=\"padding:13px;vertical-align:top;\"><strong>M\u00e1ximo de gastos personales<\/strong><\/td>\n<td style=\"padding:13px;vertical-align:top;\">Limite anual en la participaci\u00f3n en los costos dentro de la red<\/td>\n<td style=\"padding:13px;vertical-align:top;\">$6,000<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n\n\n\n<h2 id=\"h-what-does-a-year-of-aba-therapy-cost-with-insurance\" class=\"wp-block-heading\">\u00bfCu\u00e1nto cuesta un a\u00f1o de terapia ABA con el seguro?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Un plan de ejemplo muestra c\u00f3mo se combinan los elementos. Los n\u00fameros que se muestran a continuaci\u00f3n son para ilustraci\u00f3n y <a href=\"https:\/\/bluegemsaba.com\/es\/does-blue-cross-blue-shield-cover-aba-therapy-in-massachusetts\/\" style=\"text-decoration:underline;\">Tu propio plan ser\u00e1 diferente<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Supongamos que su plan tiene un l\u00edmite de $2.000 para el pago propio, una cuota de 20% para la copagosidad y un m\u00e1ximo de $6.000 para los gastos personales. Su hijo recibe 15 horas de terapia por semana y el monto permitido por el plan es de $100 por hora. Esto arroja un total de $1.500 de terapia cubierta cada semana.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Habr\u00edas de cubrir el monto deducible durante la segunda semana. A partir de entonces, deber\u00edas pagar 20% euros por cada una de las sesiones de la semana, o un total de $300. A ese ritmo, llegar\u00edas al m\u00e1ximo de $6.000 aproximadamente en la 15\u00aa semana de terapia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Durante el resto del a\u00f1o de plan, las sesiones cubiertas no te costar\u00e1n nada. Tu total para el a\u00f1o ser\u00eda de $6.000, aproximadamente $78.000 horas de terapia cubiertas.<sup><a href=\"#ref-5\" style=\"text-decoration:underline;\">5<\/a><\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Los planes de copagos funcionan de manera diferente. Un copago de $25 por cada d\u00eda de sesiones, cinco d\u00edas a la semana, suma un total de $125 por semana. Durante un a\u00f1o completo, eso asciende a unos $6.500, a menos que el m\u00e1ximo que cubre el plan impida que llegue a ese monto antes.<\/p>\n\n\n\n<h2 id=\"h-how-does-the-out-of-pocket-maximum-protect-your-family\" class=\"wp-block-heading\">\u00bfC\u00f3mo protege el m\u00e1ximo de gastos personales a tu familia?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Para una familia que utiliza la terapia ABA, el m\u00e1ximo de gastos personales suele ser el n\u00famero que m\u00e1s importa. Las sesiones frecuentes hacen que muchas familias lo alcancen en los primeros meses del a\u00f1o de planificaci\u00f3n.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La ley federal fija un l\u00edmite m\u00e1ximo para los planes de seguro de salud. Para los planes de 2026, el l\u00edmite es de $10.600 para una persona y de $21.200 para una familia. Para los planes de 2027, el l\u00edmite aumenta a $12.000 y $24.000. Muchos planes de empleadores fijan un l\u00edmite m\u00e1ximo inferior al permitido por la ley.<sup><a href=\"#ref-7\" style=\"text-decoration:underline;\">7<\/a><\/sup><sup><a href=\"#ref-8\" style=\"text-decoration:underline;\">8<\/a><\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Algunos detalles afectan a c\u00f3mo funciona:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Solo los servicios cubiertos en la red de salud cuentan para el m\u00e1ximo permitido.<\/li>\n\n\n\n<li>Las primas mensuales no se cuentan.<\/li>\n\n\n\n<li>El total se restablece cuando comienza un nuevo a\u00f1o de plan, que en muchos casos es el 1 de enero.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Es por eso que los costos de ABA suelen ser m\u00e1s altos en los primeros meses del a\u00f1o de un plan. Al reservar dinero con anticipaci\u00f3n, podr\u00e1s amortizar esos meses.<sup><a href=\"#ref-6\" style=\"text-decoration:underline;\">6<\/a><\/sup><\/p>\n\n\n\n<h2 id=\"h-how-can-you-lower-what-you-pay-for-aba-therapy\" class=\"wp-block-heading\">\u00bfC\u00f3mo puede usted reducir lo que paga por la terapia ABA?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Las reglas de tu plan est\u00e1n establecidas para todo el a\u00f1o, y a\u00fan tienes varias formas de reducir tus costos.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La elecci\u00f3n de un proveedor incluido en la red es la m\u00e1s importante. Los cuidados fuera de esa red suelen conllevar un seguro de atenci\u00f3n m\u00e9dica independiente y un monto de cobertura m\u00e1s alto, y esos gastos pueden no sumarse a los l\u00edmites m\u00e1ximos de cobertura.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Si su hijo <a href=\"https:\/\/bluegemsaba.com\/es\/does-medicaid-pay-for-aba-therapy-in-columbia-maryland\/\" style=\"text-decoration:underline;\">tambi\u00e9n califica para el programa Medicaid<\/a>, Al ser un plan secundario, puede actuar como un segundo plan y cobrar copagos y primas de asistencia m\u00e9dica por los servicios que cubre.<sup><a href=\"#ref-9\" style=\"text-decoration:underline;\">9<\/a><\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Una cuenta de ahorro para la salud o una cuenta de gastos flexibles te permite pagar tu parte con dinero antes del impuesto. La terapia ABA para una condici\u00f3n diagnosticada generalmente es una partida elegible.<sup><a href=\"#ref-10\" style=\"text-decoration:underline;\">10<\/a><\/sup><sup><a href=\"#ref-11\" style=\"text-decoration:underline;\">11<\/a><\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La inscripci\u00f3n abierta es otra oportunidad para ahorrar. Al comparar los planes, considere adem\u00e1s el m\u00e1ximo de gastos propios que se debe pagar. Para un ni\u00f1o que recibe tratamiento semanal, un plan con un m\u00e1ximo m\u00e1s bajo puede resultar m\u00e1s econ\u00f3mico durante el a\u00f1o, incluso si la prima es m\u00e1s alta.<sup><a href=\"#ref-12\" style=\"text-decoration:underline;\">12<\/a><\/sup><\/p>\n\n\n\n<h2 id=\"h-blue-gems-aba-helps-families-understand-aba-therapy-costs\" class=\"wp-block-heading\">Blue Gems ABA ayuda a las familias a entender los costos de la terapia ABA<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Conocer su deducible, su copago o cofinanciaci\u00f3n y su m\u00e1ximo de gastos propios elimina gran parte de la incertidumbre que conlleva pagar por la terapia ABA.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En <a href=\"https:\/\/bluegemsaba.com\/es\/\" style=\"text-decoration:underline;\">Blue Gems ABA<\/a>, nuestro <a href=\"https:\/\/bluegemsaba.com\/es\/intake-process-timeline\/\" style=\"text-decoration:underline;\">Los especialistas en seguros contactan a su operador de telefon\u00eda m\u00f3vil<\/a> Para confirmar los beneficios del ABA para su hijo. Nosotros <a href=\"https:\/\/bluegemsaba.com\/es\/we-help-with-insurance\/\" style=\"text-decoration:underline;\">revise los costos previstos con usted<\/a> <a href=\"https:\/\/bluegemsaba.com\/es\/aba-intake-checklist\/\" style=\"text-decoration:underline;\">antes de que comience la terapia<\/a>, Por lo tanto, el primer proyecto de ley no es una sorpresa.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Para m\u00e1s informaci\u00f3n <a href=\"https:\/\/bluegemsaba.com\/es\/contact\/\" style=\"text-decoration:underline;\">Cont\u00e1ctenos<\/a> Hoy.<\/p>\n\n\n\n<section style=\"margin:32px 0;padding:24px;background:#f4f7fb;border-radius:10px;border-top:4px solid #0f2c5a;\">\n<h2 style=\"color:#0f2c5a;margin-top:0;\">Preguntas frecuentes<\/h2>\n<ol style=\"padding-left:22px;line-height:1.7;\">\n<li style=\"margin-bottom:16px;\"><strong>\u00bfTengo que cumplir con mi cuota de pago antes de que la cobertura de seguro pague la terapia ABA?<\/strong>\n<p>Eso depende de tu plan. Algunos requieren que primero cumplas con el monto deducible, mientras que otros cubren ciertos servicios antes de que se cumpla el monto deducible.<\/p><\/li>\n<li style=\"margin-bottom:16px;\"><strong>\u00bfSe cobra una copago de la terapia ABA por hora o por visita?<\/strong>\n<p>Depende del plan de seguro y de c\u00f3mo se facturan los servicios. Pregunte a su aseguradora si la copagosiva se aplica por visita, servicio o d\u00eda.<\/p><\/li>\n<li style=\"margin-bottom:16px;\"><strong>\u00bfLa terapia ABA se incluye en el l\u00edmite m\u00e1ximo de gastos personales?<\/strong>\n<p>En general, el monto de su deducible, los copagos y la cofinanciaci\u00f3n para la terapia ABA cubiertos en la red cuentan para el monto m\u00e1ximo aplicable. Consulte los documentos del plan para conocer las reglas espec\u00edficas de cobertura.<\/p><\/li>\n<li style=\"margin-bottom:16px;\"><strong>\u00bfPuede el programa Medicaid ayudar a pagar los copagos de la terapia ABA?<\/strong>\n<p>El programa Medicaid puede ayudar a cubrir los gastos de participaci\u00f3n en el costo cuando un ni\u00f1o tambi\u00e9n tiene una cobertura privada de salud. Las normas de cobertura y pago dependen del estado y de los servicios involucrados.<\/p><\/li>\n<li><strong>\u00bfSe restablecer\u00e1 el deducible de mi terapia ABA cada enero?<\/strong>\n<p>Muchos planes de seguro restablecen el monto del deducible el 1 de enero, pero otros siguen un plan diferente durante el a\u00f1o. Su compa\u00f1\u00eda de seguros puede confirmar la fecha de restablecimiento.<\/p><\/li>\n<\/ol>\n<\/section>\n\n\n\n<section style=\"margin:32px 0;\">\n<h2 style=\"color:#0f2c5a;\">Referencias<\/h2>\n<ol style=\"padding-left:24px;line-height:1.7;overflow-wrap:anywhere;\">\n<li id=\"ref-1\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/glossary\/deductible\/\" style=\"text-decoration:underline;\">Deducible<\/a>.<\/li>\n<li id=\"ref-2\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/glossary\/co-payment\/\" style=\"text-decoration:underline;\">Cofinanciaci\u00f3n<\/a>.<\/li>\n<li id=\"ref-3\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/glossary\/co-insurance\/\" style=\"text-decoration:underline;\">Coaseguro<\/a>.<\/li>\n<li id=\"ref-4\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/glossary\/allowed-amount\/\" style=\"text-decoration:underline;\">Cantidad permitida<\/a>.<\/li>\n<li id=\"ref-5\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/glossary\/co-insurance\/\" style=\"text-decoration:underline;\">Coaseguro y participaci\u00f3n en los costos<\/a>.<\/li>\n<li id=\"ref-6\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/glossary\/out-of-pocket-maximum-limit\/\" style=\"text-decoration:underline;\">M\u00e1ximo\/Limite de Gastos Personales<\/a>.<\/li>\n<li id=\"ref-7\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/glossary\/out-of-pocket-maximum-limit\/\" style=\"text-decoration:underline;\">Limites anuales por cuenta propia<\/a>.<\/li>\n<li id=\"ref-8\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/SBC-GLOSSARY\/\" style=\"text-decoration:underline;\">Resumen de beneficios y coberturas<\/a>.<\/li>\n<li id=\"ref-9\">Medicaid.gov. <a href=\"https:\/\/www.medicaid.gov\/medicaid\/eligibility-policy\/coordination-of-benefits-third-party-liability\" style=\"text-decoration:underline;\">Coordinaci\u00f3n de beneficios y responsabilidad de terceros<\/a>.<\/li>\n<li id=\"ref-10\">Servicio de Impuestos Internos. <a href=\"https:\/\/www.irs.gov\/publications\/p969\" style=\"text-decoration:underline;\">Publicaci\u00f3n 969: Contas de ahorro para salud y otros planes de salud con ventajas fiscales<\/a>.<\/li>\n<li id=\"ref-11\">Servicio de Impuestos Internos. <a href=\"https:\/\/www.irs.gov\/publications\/p502\" style=\"text-decoration:underline;\">Publicaci\u00f3n 502: Gastos m\u00e9dicos y dentales<\/a>.<\/li>\n<li id=\"ref-12\">HealthCare.gov. <a href=\"https:\/\/www.healthcare.gov\/choose-a-plan\/your-total-costs\/\" style=\"text-decoration:underline;\">Su coste total de atenci\u00f3n sanitaria<\/a>.<\/li>\n<\/ol>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>\u201cYour insurance covers ABA therapy&#8221; is welcome news, and it still leaves most parents wondering what they&#8217;ll owe. Coverage means your plan will pay for applied behavior analysis (ABA therapy) under its rules. Those rules usually leave part of the bill with you, through a deductible, copays or coinsurance.123 The terms are easy to mix [&hellip;]<\/p>\n","protected":false},"author":10,"featured_media":46928,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"template-single-blog.php","format":"standard","meta":{"page_builder":"","footnotes":""},"categories":[40,49],"tags":[],"class_list":["post-46926","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-aba-therapy","category-insurance"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.3 (Yoast SEO v28.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>ABA Therapy Deductibles, Copays and Coinsurance: What Parents Actually Pay - Blue Gems ABA Therapy<\/title>\n<meta name=\"description\" content=\"How much will you pay for ABA therapy with insurance? 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