Use AI to compare health plans when your child is in therapy

A lot of parents now paste their open enrollment options into ChatGPT, Claude, Gemini, or Copilot and ask which plan is better. That can be a real help, especially when one of the biggest costs on the table is therapy you already know your child will need. But the answer is only as good as what you give it. This guide gives you a prompt you can copy, the cash prices Austin-area clinics publish so you have real numbers to put in it, and three example families to show what the math can look like.

I’m not a financial advisor, and this isn’t tax or financial advice. Every family’s numbers are different. It’s a way to see your own numbers clearly before you choose.

What we did

For us, it came down to two choices: a high-deductible plan with an HSA, or a lower-deductible plan without one. What decided it was whether we had a medically complex child (early on we did; now we don’t) and how much therapy we knew she’d need.

When she was little, in and out of the NICU and PICU and seeing a long list of specialists on top of therapy, we had low-deductible plans with higher monthly premiums. Therapy back then was four sessions a week: speech, feeding, occupational, and physical therapy. As she got older, the specialist visits spread out, but therapy stayed steady. That’s when we switched to the plan with lower premiums and an HSA. Today her week is two 30-minute speech sessions and one longer occupational therapy session for feeding.

You can’t predict a broken arm or a car accident; you can only cushion against them. But therapy may be the one big cost you know is coming, and planning around it may matter more than planning around the what-ifs. I’ll be honest: therapy is still one of the largest bills we pay every month. Paying for it isn’t easy. But there are ways to make it weigh less on the budget.

Even in network, it isn’t simple. Last year her speech clinic was in network, and we still paid a $40 copay for every session, twice a week, all year. Feeding therapy we paid for out of pocket, $170 a session, once a week. That’s about $250 a week for therapy before a single premium payment, and it never let up.

None of the feeding money counted toward our out-of-network maximum. Our plan didn’t care that we couldn’t find anyone in network, so sending in superbills wasn’t an option for us either. Some plans will make an exception when no in-network clinic can see your child (our guide to paying for therapy explains how to ask), but don’t count on it when you run the numbers.

Before you start: what to gather

• Each plan’s summary of benefits. Your employer or the marketplace has one for every plan. It lists the premium, deductible, out-of-pocket maximum, and what therapy visits cost.
• Your therapy schedule for next year. Which therapies, how many times a week, and whether that’s likely to change. Your child’s therapist can help you estimate.
• Two prices for each therapy. Ask the front desk for both: what your plan pays them for one session (the price your deductible and coinsurance are based on), and what they charge in cash for the same session. They’re often different, and the math needs both. If you’ll pay without insurance, clinics usually have to give you a written Good Faith Estimate when you schedule at least three business days ahead or when you ask. If the bill comes in $400 or more above it, you can dispute it.

What to leave out

The AI doesn’t need to know who you are. Leave out names, birthdates, member ID numbers, and diagnosis codes. “Speech therapy twice a week” is all it needs. A plan’s summary of benefits is the same document every member gets, so it’s fine to paste.

The prompt

Tap the button to copy it, paste it into whichever AI assistant you use, and fill in the brackets there.

I'm choosing a health insurance plan for my family for next year. I'm not asking you to pick one for me. I want to understand the tradeoffs.

Here is my child's therapy schedule. We expect it to keep going all year:
- [Speech therapy]: [2] sessions a week, [30] minutes each. The clinic is [in network / out of network / cash only]. Plan's price per session (what the plan pays the clinic, before my copay): $[amount]. Cash price per session: $[amount].
- [Occupational therapy for feeding]: [1] session a week, [60] minutes. The clinic is [in network / out of network / cash only]. Plan's price per session: $[amount]. Cash price per session: $[amount].
- [Add a line for each other therapy: physical therapy, ABA, and so on.]
[If you don't know a price, write "unknown" and the AI will tell you what to ask.]
[Add other regular care, like specialist visits, if you have it.]

Here are the plans I can choose from:
[For each plan, paste the monthly premium; the deductible and out-of-pocket maximum, both in network and out of network; the copay or coinsurance for therapy visits, before and after the deductible; any limit on therapy visits per year, for each therapy type; and whether it comes with an HSA, and how much my employer puts into the HSA each year. Or paste the text of each plan's summary of benefits.]

Please:
1. Estimate what each plan would cost us for the year: premiums plus what we'd pay for each therapy. Count every session of every therapy, and use the in-network or out-of-network numbers for each clinic. Show the math step by step, in a table.
2. Do it again for a bad year: add one unexpected $4,000 medical bill in the fall.
3. For any plan with an HSA, add a version where we pay the therapy clinic in cash instead of through insurance. Remember that cash payments usually don't count toward the deductible.
4. If a plan limits therapy visits, show the week each therapy runs out of covered visits, and what the rest of the year would cost at the clinic's cash price. Tell me whether the limit is shared between in-network and out-of-network visits.
5. List what you couldn't find in what I pasted, and the questions I should ask the plan or the clinic before I decide.

Explain it in plain language.

When the answer comes back, check each line of the math with your phone’s calculator. AI assistants can get arithmetic wrong, and they can misread a plan document. That’s why the prompt asks it to show its work.

What clinics charge in cash

Most clinics don’t post prices. We looked at about 240 Austin-area pediatric therapy clinic websites, and about 20 publish a cash price you can use. Here is the range of what they list, checked October 23, 2026. Your clinic’s own price beats any range, so ask.

Why so many clinics are cash only. What insurers pay clinics often hasn’t kept up. In 2015, Texas cut what Medicaid pays for children’s therapy by about $260 million over two years, and Medicare’s rates for speech therapy are still being cut in 2026. Meanwhile the average family premium through work rose 26% in five years. Many clinics respond by limiting how many insured patients they take, or by not taking insurance at all.

If your child has Medicaid: a clinic that takes Medicaid can’t charge you cash for a service Medicaid covers. It can bill you only for services Medicaid doesn’t cover.

Compare by the hour, not by the session. Short sessions often cost more per hour. One clinic we looked at charges $200 an hour for a 30-minute session and $150 an hour for a 60-minute one.

ABA is priced differently. It’s billed by the hour, and programs often run many hours a week. One Austin practice lists $150 an hour for time with the supervising behavior analyst and $75 an hour for time with a therapy technician. At those rates, 20 hours a week comes to about $1,800 a week. For most families, that’s a cost where a plan’s out-of-pocket maximum matters more than anything else. Our ABA enrollment guide covers how hours are set.

Four example families

These families and plans are made up, but the plans are built from real numbers: national averages for plans people get through work, and the Austin-area plans sold on the marketplace this year. The numbers are round on purpose, so the math is easy to follow. Both are employer plans, where the employer pays most of the premium and you pay a share. Both plans are the same in every example:

• Plan A, the copay plan: your share of the premium is $575 a month ($6,900 a year). Each therapy visit costs a $45 copay at in-network clinics. The most one person pays for in-network care in a year is $4,500.
• Plan B, the high-deductible plan with an HSA: your share is $350 a month ($4,200 a year). You pay the plan’s full price for care until you’ve paid $5,000 (the deductible), then 20%. The most one person pays for in-network care in a year is $8,000.

Every family plan also has a higher maximum for the whole family, but no one person pays more than the individual maximum. That’s a federal rule for marketplace plans and most employer plans, so when one child has most of the care, the individual number is the one that counts. Real plans have more moving parts. Many high-deductible plans switch to a copay after the deductible instead of a percentage. Many employers also put money into your HSA each year. Plans with out-of-network coverage have a separate deductible and maximum for it, and what you pay out of network doesn’t count toward the in-network ones. These examples use in-network numbers only, and assume the plan covers every visit; the next section shows what a visit limit does. The prompt asks for all of it, so paste all of it.

If you buy your own plan, as many self-employed families do, there’s no employer paying most of the premium, and yours can be several times these numbers. The math works the same way, but a bigger gap between premiums can change which plan wins. Put your real numbers in the prompt.

1. A big medical year

A baby home from the NICU, with specialist follow-ups and four therapy sessions a week: speech, feeding, occupational, and physical therapy. The baby’s care costs more than either plan’s individual maximum, so both plans hit it.

• Plan A: $6,900 premiums + $4,500 maximum = $11,400
• Plan B: $4,200 premiums + $8,000 maximum = $12,200

In a year like this, premiums plus the out-of-pocket maximum is the number to compare, and it’s closer than most people expect: Plan A wins by $800. If your employer puts money into the HSA, count it on Plan B’s side. A $1,000 deposit would make Plan B the cheaper one here.

2. Steady therapy, little else

An older child in speech therapy once a week for the school year, 35 weeks, with few other medical bills. The clinic the family wants doesn’t take insurance and charges $120 for a 45-minute session. On Plan A, they’d have to use an in-network clinic. On Plan B, they pay cash at the clinic they chose.

• Plan A, in-network clinic: $6,900 premiums + (35 visits × $45) $1,575 = $8,475. The copays stay under Plan A’s $4,500 maximum.
• Plan B, cash at their clinic: $4,200 premiums + (35 visits × $120) $4,200 = $8,400. Cash payments don’t count toward Plan B’s maximum, so nothing caps them.

Plan B comes out a little cheaper here, and the family isn’t limited to in-network clinics or their waitlists. If they pay those therapy bills with HSA money, which goes in before income tax, or their employer adds to the HSA, the real cost is lower still. A plan that “includes” therapy can still limit who you see and charge a copay at every visit, and in some years paying cash comes out ahead.

Cash adds up fast with more sessions, though. Three $120 sessions a week for 48 weeks is $17,280, more than twice Plan B’s $8,000 maximum if the same visits had gone through insurance. That’s why the prompt asks for every therapy and every session.

3. The same family, with a surprise in October

Same year as example 2, plus a broken arm and a $4,000 emergency room bill in October. Here is the catch: cash payments usually don’t count toward your deductible, unless you file them with the plan as a claim. So on Plan B, the family has paid $4,200 for therapy but still hasn’t met any of the deductible, and the whole emergency bill is theirs. On Plan A, say the emergency visit costs a $500 copay.

• Plan A: $8,475 + $500 = $8,975. Copays plus the emergency copay come to $2,075, still under the $4,500 maximum.
• Plan B: $8,400 + $4,000 = $12,400. The $4,000 bill is all deductible, because the cash payments never counted toward it.

One surprise flipped the answer by more than $3,000. Paying cash on a high-deductible plan works best when you could afford a big bill on top of it. Before you count on it, ask the plan whether cash payments, or a superbill you send in, would count toward the deductible.

4. A family that buys its own plan

Self-employed parents with no employer plan, buying on the marketplace for themselves (both 40) and their 8-year-old. Nobody else pays part of the premium. These numbers come from 2026 Austin-area prices for one insurer’s standard plans, scaled to the family with the federal age-rating table, before any help paying the premium:

• Bronze: about $1,650 a month ($19,800 a year). $7,500 deductible. The most one person pays for care in a year is $10,000.
• Gold: about $2,300 a month ($27,600 a year). $2,000 deductible. The most one person pays is $8,200.

In a big year, when their child hits the individual maximum on either plan:

• Bronze: $19,800 premiums + $10,000 maximum = $29,800
• Gold: $27,600 premiums + $8,200 maximum = $35,800

Bronze wins by $6,000, even in the worst year. Here’s the quick check: Gold costs $7,800 more a year in premiums, so it only comes out ahead if it saves you more than $7,800 on care. In the worst year it saves $1,800. Gold can still win in some middle years, when its lower deductible matters most, so run a normal year too. The prompt does both.

Older parents, more children, or a richer plan push premiums higher still. And in the prices we looked at, the standard silver plan cost more each month than the standard gold plan. Don’t assume the metal levels are in price order.

Help with the premium. For 2026, the extra help Congress had added to marketplace plans expired. A family earning more than four times the federal poverty level, about $106,600 for a family of three, now gets no help with the premium. Unless Congress changes it, 2027 works the same way. Healthcare.gov shows what you qualify for when you shop.

When the plan runs out of visits

Many plans cap therapy visits each year. In the Austin-area marketplace plans we looked at for 2026, the cap was 35 visits a year, with habilitative therapy (learning a new skill) and rehabilitative therapy (getting one back) counted separately. Some plans apply the cap to each therapy type. Others share one cap across speech, occupational, and physical therapy, which runs out much faster. Some don’t apply it to developmental delays at all. The plan’s summary of benefits may say which; if it doesn’t, call the number on the plan document.

Say the cap is 35 visits for each therapy. How long that lasts depends on how often your child goes:

• Twice a week: 35 visits are gone in about 17 weeks, about 4 months.
• Once a week: 35 visits last 35 weeks, about 8 months.

Take a child in speech twice a week and occupational therapy for feeding once a week, on Plan A (the copay plan) with that 35-visit cap, over a 48-week year:

• Speech: 96 visits needed, 35 covered, 61 not covered. At $100 for a 30-minute session, that’s $6,100.
• Feeding OT: 48 visits needed, 35 covered, 13 not covered. At $150 for a 60-minute session, that’s $1,950.
• Covered visits: 70 copays × $45 = $3,150, under Plan A’s $4,500 maximum.

That’s $8,050 on top of the copays, and $18,100 for the year with premiums. Why doesn’t the $4,500 maximum stop it? Because the maximum only counts care the plan covers. What you pay for visits past the cap, care out of network, and premiums don’t count toward it. Ask the clinic what they charge once covered visits run out; it may be their cash price. And if the plan shares one 35-visit cap across both therapies, it runs out in under 12 weeks.

That’s also why getting more visits approved is worth the paperwork. If the plan approved every visit this family needed, all 144 would be $45 copays, $6,480, and the $4,500 maximum would stop it there. The year would cost $11,400 instead of $18,100.

Three questions to ask the plan about the cap:

• Can more visits be approved? Some plans add visits when your child’s doctor or therapist shows they’re medically needed. Ask how, and how long approval takes. Waiting for approval can leave a gap in therapy.
• Is the cap per therapy, or shared? Ask whether speech, occupational, and physical therapy each get their own visits, and whether in-network and out-of-network visits share them.
• Does it count visits or units, and does habilitative therapy have its own cap? Our open enrollment guide explains what habilitative means and why it matters.

In network or out of network: what one visit costs

Made-up numbers again, for one covered visit after the deductible is met:

• In network: the clinic agreed to the plan’s price. You pay your copay or coinsurance, say $45. It counts toward the in-network deductible and maximum.
• Out of network: the clinic charges $150. The plan says the visit is worth $100 and pays 60% of that, $60. You pay the other $90. The clinic didn’t agree to the plan’s price, so it can bill you the difference. Before the separate out-of-network deductible is met, you pay all $150. What you pay counts toward the out-of-network deductible and maximum, not the in-network ones.

Many plans pay nothing out of network. Almost every Austin-area marketplace plan we looked at is an HMO or EPO that covers out-of-network care only in an emergency. On those plans, every visit to an out-of-network clinic is its full price, the same as paying cash.

If you have an HSA: pay now, pay yourself back later

Some people treat their HSA as a long-term savings account. They pay medical bills from checking, save every receipt, and leave the HSA money invested. Money in an HSA grows without being taxed. Later, as long as they kept the receipts, they can take out what they spent, tax free.

It only works if:

• you can afford to pay the bills when they come
• the care happened after you opened the HSA
• insurance didn’t pay you back for it, and you didn’t deduct it on your taxes
• you keep the receipts

Invested money can go down as well as up. The HSA stays yours if you change jobs or plans. The rules are in IRS Publication 969, and your HSA administrator has the final word on your account. Our guide to paying for therapy covers which therapies count and how to file for reimbursement.

What AI can’t tell you

• Whether your clinic is in network next year. Only the clinic and the plan know. Ask the clinic by plan name and network name. To make your list of clinics to call, see which clinics list your plan on Care Connect Kids, then confirm with each one.
• The real visit limits. Plan summaries can be vague about therapy. If the summary doesn’t say, call the number on the plan document.
• What your year will bring. The prompt’s “bad year” step is there because nobody knows.

Our open enrollment guide has the full list of what to ask, in order, and the deadlines that count.

Finding pediatric therapy in Central Texas

Care Connect Kids is free for families. Always. Clinics pay for the platform, and speech, occupational, physical, and ABA therapy all live in one place.

Not sure whether we reach your family yet? Check your zip code. If you are in Central Texas, the Austin metro page shows where we cover today.