Autism services through health insurance

Most health insurance plans should cover some therapies and services for people with autism.

Make sure to learn what you qualify for, and to use every service you can get!

How can I find out what's covered in my plan?

  • If you have a Member Handbook or List of Covered Services, look to see what your plan covers.

  • Call the number on the back of your health insurance card. 

  • Look on the website for your insurance company.

Look into MassHealth (Medicaid):

  • If your child is diagnosed with autism, they may qualify for MassHealth, even if your family does not. (People can qualify because of a disability rather than income.)

  • MassHealth includes good benefits for people with disabilities, including autism.

Click on the boxes below to learn more:

In 2010, Massachusetts passed a law called ARICA: Act Relative to Insurance Coverage for Autism.

This requires certain private insurance companies to cover services for autism like ABA and other therapies.

To learn more, see these Fact Sheets from the Autism Insurance Resource Center website:

(Click on the title to open it in a new tab. Also in Spanish and Vietnamese)

If you need help, see the Autism Insurance Resource Center website or call them at 744-455-4056.

 

Source: The Autism Insurance Resource Center, E. K. Shriver Center, University of Massachusetts Medical School

MassHealth will cover ABA and other therapies for people with autism who are:

  • Under 21 and have MassHealth Standard or MassHealth CommonHealth

  • Under 19 and have MassHealth Family Assistance (Note that this is not the same as Premium Assistance)

MassHealth started to cover ABA in 2015. You can get ABA through MassHealth, but you'll need prior authorization. This is a formal approval from your insurance before they can pay for the services.

Here's how to get coverage for ABA or other therapies:

  1. Find a therapy provider. See our Resource Directory to search for providers near you.

  2. Have your provider contact MassHealth at 617-847-3786 to request prior authorization.

  3. Call the number on the back of your MassHealth card if you have questions.

If you need help, call the Autism Insurance Resource Center at 744-455-4056. Or see this Fact Sheet on their website:  Accessing ABA therapy through insurance. (Click on the title to open it in a new tab.)

Sources: Autism Insurance Resource Center, Shriver Center of UMass Medical School

 

Once you know what is covered, use the Exceptional Lives Resource Directory to find services in your area.

En Español: Directorio de recursos.

If you have MassHealth, click on the box that says: Show only providers who accept MassHealth (Medicaid) for some or all services.

Source: Centers for Medicare & Medicaid Services

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