Insurance Resource Center for Autism and Behavioral Health

11/20/2025

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!

11/12/2025

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

11/06/2025

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.

11/03/2025

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.

10/29/2025

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 💙

10/27/2025

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

10/23/2025

Reminder!

ASK THE INSURANCE GURU:

"Hi Guru,

The Insurance Resource Center has been such a wonderful help to our family. We were wondering if you know of any ways we could either get involved or make a donation to support their work.

Gratefully,
A Thankful Family"

Dear Thankful Family,

Thank you so much for your kind words and support for the work the Insurance Resource Center for Autism and Behavioral Health does for so many families. I spoke with the team, and they shared that each year the Insurance Resource Center participates in the Doug Flutie 5K for Autism. All donations raised by their team go directly toward supporting their ongoing programs and services.

This year’s event will be held on Sunday, October 26th at 9:00 AM at Natick High School. It’s a fun, family-friendly event, and the Insurance Resource Center would be thrilled to have you join The Gurus & Friends Team or contribute with a donation.

You can join or donate here: https://runsignup.com/Race/186352/Donate/UGpBpubZ1m0Z0Gc7

Warmly,
Guru

10/22/2025

💙 Thank you so much for your support!

The Gurus & Friends are gearing up to run the Flutie 5K for Autism this Sunday, and we’re so grateful for everyone who has donated so far — together we’ve raised $6,936! 🙌

We’re getting close, but we still need your help to cross the finish line and reach our $15,000 goal in support of the Insurance Resource Center for Autism & Behavioral Health.

As a Flutie 5K Charity Partner, 100% of the funds raised by our team go directly to the Center so we can continue helping families navigate the complex world of health insurance and access the care they need.

Every dollar makes a difference — thank you for your generosity and continued support! 💙

To donate, please click the link below…

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

10/19/2025

One week to go! The Gurus & Friends have raised $6.521! 🎉🎉🎉 We are so grateful for your generosity!

💙 Thank you to everyone who donated and supported the Insurance Resource Center for Autism & Behavioral Health in the Flutie 5k. Because of you, we’re able to continue making a difference! Every contribution—big or small—helps us move closer to our goal. We couldn’t do this without you! 🎉

To make a donation, click the link below 💙

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

10/16/2025

ASK THE INSURANCE GURU:

"Hi Guru,

My son has MassHealth CommonHealth with Premium Assistance based on the family health insurance we receive through my employer. My employer’s open enrollment starts next week, and I want to make sure that we can maintain the Premium Assistance. What do I need to know to make sure it stays in place?

Thanks!"

Great Question!

Premium assistance is reviewed on an annual basis to ensure your employer sponsored plan still meets the criteria for reimbursement. During open enrollment you want to confirm that the plan you select, whether it is the same plan as this year or a new plan, still qualifies for the program. For a family plan, you want to make sure that the in-network family deductible is no more than $5900 and the out-of-pocket max is no more than $18,400.
Next, you want to make sure that Premium Assistance receives the updated information as soon as possible. This would include a completed Premium Assistance Review Form: https://www.mass.gov/doc/premium-assistance-compliance-form/download, and a summary of benefits for the 2026 plan year. Premium Assistance will ask your employer for this information. If they don’t receive it from them, they will ask you for this information. A good tip is when you are speaking with your HR during open enrollment have them complete the review form for you and make sure it is submitted.

Keep in mind that Premium Assistance sends their reimbursement out a month in advance. This means that your December Premium Assistance benefit is for your January coverage. Premium Assistance needs the new plan year’s information by mid-November, to continue your benefit for the next plan year with no delay.

Another reminder is that Premium Assistance generally matches what you are paying for your employer sponsored insurance, so review all your options. Perhaps there is a more expensive plan that you should consider. If you have questions or would like help in reviewing your options, feel free to reach out to the Insurance Resource Center.

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".

10/15/2025

Weekly update! 🎉🎉🎉 The Gurus & Friends have raised $5,971! We are so grateful for your generosity!

💙 Thank you to everyone who donated and supported the Insurance Resource Center for Autism & Behavioral Health in the Flutie 5k. Because of you, we’re able to continue making a difference! Every contribution—big or small—helps us move closer to our goal. We couldn’t do this without you! 🎉

To make a donation, click the link below 💙

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

Doug Flutie, Jr. Foundation for Autism

10/14/2025

https://umassmed.zoom.us/meeting/register/u6bzmaxzQdih8OCXb6OQpw