Insurance Resource Center for Autism and Behavioral Health

11/12/2025

ASK THE INSURANCE GURU:

"Dear Guru,

My family has been relying on MassHealth premium assistance for a few years now. My husband’s health premium is going way up in 2026. He will be paying $1400/month for the family plan! Did the 2026 deductible rates or reimbursement change for 2026?

Fingers crossed!"

Dear Fingers crossed,

Yes, you are in luck and can uncross your fingers!! Premium assistance deductibles and reimbursement rates have increased for 2026. The maximum in-network deductible has increased to $3,200 for an individual and $6,400 for the family.

The individual maximum out-of-pocket has increased to $10,150. The family coverage maximum out-of-pocket has increased to $20,300. As long as your employer health plan is at or under these maximums, it should meet eligibility guidelines.

The Premium Assistance monthly reimbursement rates are as follows:

MassHealth: up to $1,835 per month
Standard disabled: up to $1,835 per month
Standard, not disabled: up to $457 per month
Family Assistance: up to $457 per month

Please remember to renew your premium assistance annually as soon as you complete your employer health plan open enrollment!
If you have questions about premium assistance, the number to call is 1.800.862.4840.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

08/12/2025

Click here to register: https://mdsc.zoom.us/webinar/register/WN_24xQ477eTpmLJ6iGcqC0oA?fbclid=IwY2xjawOj73BleHRuA2FlbQIxMABicmlkETFzczhjcDJYTjdVVlM2RE9nc3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHvaYueewo8VlnaOZBNyGFtipnH_oZ81fc5irV67f71JtMkIWuIOQl66PAD3W_aem_Gkb5Ds5z8r7ntENd2zJrBg #/registration

04/12/2025

ASK THE INSURANCE GURU:

"Hi Guru,

We have MassHealth, which has allowed my 15-year-old son to get out-patient therapy. My son’s therapist asked me what I thought about trying “TM” services. Once I figured out that TM is an acronym for Therapeutic Mentoring and learned a bit about it, I think it sounds like something that could be helpful. Can you tell me a little more about Therapeutic Mentoring services.

Thanks,

-Looking to learn about TM"

Dear Looking to Learn About TM,

Yes, Therapeutic Mentoring (“TM”) services can be very helpful for youths who are struggling. I tend to think of it as a skill building service. TM pairs a youth under age 21 with a mentor to help improve their social, communication and life skills in accordance with their Behavioral Health Treatment Plan.

- The TM will provide one-on-one support or coaching to help the youth with problem-solving, social skills, communication, or conflict resolution.

- The TM will practice and reinforce these new skills in a safe and appropriate setting so the youth will be able to learn how to use them.

- This skill building aims to address the goals included in the youth’s Behavioral Health treatment plan.

- Therapeutic Mentoring is a “hub-dependent” service. This means that in order to use TM services, the youth must already receive out-patient therapy, in-home therapy, Intensive Care Coordination or another MassHealth “hub” service. A referral will need to be provided from a MassHealth “hub” service, as these hubs are tasked with collaborating with state agencies and other providers to help youth and families get the right services and well-coordinated care.

- TM services need to be Medically Necessary.

So, if your child’s “hub” is suggesting TM, you may want to consider taking advantage of the benefit. You should, of course, discuss how TM services fit with your child’s Behavioral Health Treatment Plan. In many cases, it is a great fit and helps achieve established goals.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

04/12/2025

https://umassmed.zoom.us/meeting/register/cVCgtjFYSg-t_ouuqZWfJw

02/12/2025

This , we’re asking for your continued support of the Insurance Resource Center for Autism & Behavioral Health. 💙

For many families—especially those new to an autism diagnosis—understanding insurance coverage, securing services, and managing out-of-pocket costs can feel overwhelming. That’s where we come in.

We work with families to:
• Obtain MassHealth as secondary insurance
• Resolve gaps in coverage
• Navigate behavioral health denials
• Keep services running without interruption

Our mission is simple: help families make sense of a complex health insurance system and ensure their children get the care they need. And our support is always free of charge.

Your generosity helps us continue this critical work. Thank you for standing with us. 💛

Ways to donate:
Online: Through our secure link: https://bit.ly/DonateAIRC

Phone: 508-856-5615

Check: Please make payable to the UMass Chan Medical School Foundation – Insurance Resource Center, and mail to: UMass Medical School, Office of Advancement, 333 South Street, Shrewsbury, MA 01545

Donor Advised Fund UMass Chan Medical School Foundation Tax ID -04-3108190. Specify Insurance Resource Center in your Memo

21/11/2025

https://www.facebook.com/share/p/1CqqyHG3Rc/?mibextid=wwXIfr

Through advocacy, programs that promote inclusion, and engaging the community, The Arc creates tangible changes in the community and in the lives of people with disabilities.

20/11/2025

ASK THE INSURANCE GURU:

"Hi there,

I’m hoping somebody can help us. We had health insurance through the Health Connector for our entire family. Our son was receiving care at an out-of-state residential treatment center which was covered by the Health Connector plan. Everything was fine! Then we were advised to apply for MassHealth for our son. We did and it got approved, but it also ended his Health Connector coverage and MassHealth will not cover an out-of-state provider. Please help!

Frantic Mom"

Hi Frantic Mom,

Please call the IRC, and they can help you restore your son’s Health Connector coverage.

For our readers, it’s important to know that through the Health Insurance Exchange (HIX) — www.mahealthconnector.org — an individual can only have one type of comprehensive health coverage at a time.

Here’s how the system works:
• It first checks eligibility for MassHealth.
• If not eligible, it checks for ConnectorCare.
• Lastly, it looks at Health Connector unsubsidized plans.

When someone becomes eligible for MassHealth, the system will automatically end any existing ConnectorCare or Health Connector plan at the end of that month.

Unfortunately, the system does not allow someone to have both a Health Connector plan and MassHealth CommonHealth as secondary coverage.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

If you would like your autism insurance related questions answered by the Guru, please send them via email to AIRC@umassmed.edu with the subject line "Insurance Guru".

The Guru is happy to hear from you!

12/11/2025

Click here to register for our special presentation: https://umassmed.zoom.us/meeting/register/s9pEiEv6RK-hE5eXDUKoiQ

06/11/2025

ASK THE INSURANCE GURU:

"Hi Guru,

I just received a notice letting me know that my son was approved for MassHealth CommonHealth, but it stated that I would owe a $400 monthly premium. I don’t understand. I thought MassHealth was free if you had a disability. Can you explain? What can I do?

Nervous Dad"

Hi Nervous Dad,

MassHealth is an income-based system, regardless of disability. However, when eligibility is based on a disability, a monthly premium may apply. This premium is determined based on family size and income and it is on a sliding scale. Things you can consider:

1) Make sure that your entire family is listed on your MassHealth application and that your current income is reflected accurately. To do this you can log into your HIX application www.mahealthconnector.org, call MassHealth (800) 841-2900 or contact the IRC team.

2) If you have primary insurance through an employer you could work with the IRC to see if it meets criteria for Premium Assistance, which can help offset the MassHealth premium. For more information on Premium Assistance check out the IRC fact sheet:https://massairc.org/wp-content/uploads/2025/03/MassHealth-Premium-Assistance.pdf

3) If Premium Assistance is not available for your family, and the cost savings is less than you’ll be paying for MassHealth CommonHealth, you can end your son’s MassHealth within 60 days from the date he was approved, without owing the premium costs. You should call MassHealth and request an administrative closure be placed on his account.

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

03/11/2025

ASK THE INSURANCE GURU:

"Hi Guru,

My son currently has MassHealth CommonHealth as his secondary insurance and we receive Premium Assistance. I am currently in Open Enrollment with my employer, and I want to make sure that my Premium Assistance stays in place. Any tips on what I should do to make sure it stays active?"

Hello,

This is a great and timely question—many employers hold their open enrollment in the fall for coverage starting January 1st.
Here’s what you need to know:

1. Check if your new plan qualifies.
Whether you’re keeping your current plan or switching to a new one, make sure it still meets the requirements for Premium Assistance. The deductible and out-of-pocket maximum can’t be above certain thresholds. If you’re unsure, the Insurance Resource Center (IRC) can help you review your options.

2. Be proactive during open enrollment.
Premium Assistance will usually contact your employer to request updated information for the 2026 plan year. They’ll send a review form: https://www.mass.gov/doc/premium-assistance-compliance-form/download and ask your employer to complete it along with a copy of the 2026 plan summary.
o If Premium Assistance doesn’t receive the information from your employer, they’ll send the form to you as the policyholder.
o To avoid delays, it’s best to give your HR department a copy of the review form during open enrollment and ask them to fill it out right away.

3. Reminder
o The November check covers your December premium and is the last one for the current plan year.
o The December check will be for your new plan starting in January.

To make sure there are no gaps in your Premium Assistance, try to get all your updated information to them by mid-November if possible.

Finally, if you’d like to learn more, the IRC is hosting a Lunch and Learn session on this topic this week!

You can register here: https://umassmed.zoom.us/meeting/register/Ucuf1GRKSUiBPsiPPyalSQ

Reminder:

I am the Autism Insurance Guru and every week (or as often as I can) I answer your autism insurance related questions here on the AIRC’s page. My advice and wisdom come from years of experience dealing with autism insurance in Massachusetts, but please note anything I share is NOT intended to be legal or medical advice. I will post answers to questions that are submitted.

29/10/2025

Thank you so much for donating so generously to the Insurance Resource Center for Autism & Behavioral Health team in the Flutie 5k! With your support, we raised $9,205! 🎉

There is still time to donate, so please click the link below!

https://runsignup.com/Race/186352/Donate/UGpBpubZ1m0Z0Gc7

We had a great time at this event and enjoyed meeting families and seeing friends! We are already looking forward to next year!

Thank you again from the team at the Insurance Resource Center for Autism and Behavioral Health 💙

27/10/2025

https://umassmed.zoom.us/meeting/register/Ucuf1GRKSUiBPsiPPyalSQ