Insurance Resource Center for Autism and Behavioral Health

12/03/2026

ASK THE INSURANCE GURU:

"Hi Guru,

My son has MassHealth Standard and it covers everything we need, but our early intervention person suggested that we verify his disability.

Is this necessary?"

Eligibility for MassHealth Standard is based on income. Eligibility for MassHealth CommonHealth is based on a disability. The coverage is exactly the same, so it may not seem necessary and verifying your son’s disability won’t change his coverage. However, if your son’s disability is verified and your household income increases, he won’t lose his MassHealth coverage, it will just change over to MassHealth CommonHealth. It is like having a safety net.

In order to verify a disability, you will need to:

1) Make sure the disability is flagged on the MassHealth application at www.mahealthconnector.org. There is a question that asks, “if anyone in the household has an illness, injury or disability that has lasted or will last more than 12 months?” You will need to check the box beside your son’s name. You can also call MassHealth 1-800-841-2900.

2) Then you need to submit a disability supplement.
a. Child - https://www.mass.gov/doc/masshealth-child-disability-supplement/download
b. Adult - https://www.mass.gov/doc/masshealth-adult-disability-supplement-0/download

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.

05/03/2026

ASK THE INSURANCE GURU:

"Hi,

I am trying to figure out how the premiums for Mass Health are calculated? We currently use Mass Health as a secondary insurance for our son with a disability.

Thank you!"

Thank you for writing. MassHealth can be very helpful secondary insurance for children with disabilities, but figuring out the premium is sometimes complicated. The premium is determined using a number of different factors. Here is a link that provides details. https://www.mass.gov/info-details/masshealth-premium-schedule-for-members

If you have questions about your premium or want additional information about MassHealth Premium Assistance, my colleagues at the Insurance Resource Center would be happy to work with you.

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.

03/03/2026

Deciphering the Medical Insurance Maze:

Date: Thursday, March 19, 2026
Time: 6:30-7:30 P.M. via Webinar
To register for this workshop, R.S.V.P. by Monday, March 17th
by clicking on the link below

• Do you have questions about how MassHealth (Medicaid), Medicare, and private insurance work for your adult disabled dependent?
• What happens when you retire? What is the difference between SSDI and SSI?
• How can I utilize Premium Assistance?

Attend this free workshop to learn about navigating this often-tangled web as you pursue assisting your loved one.

03/03/2026

https://umassmed.zoom.us/meeting/register/Fq69nseSTPGTeg-B7q19RA

26/02/2026

ASK THE INSURANCE GURU:

"Dear Guru,

I submitted my MassHealth Premium Assistance application two weeks ago but haven’t heard anything yet. I called MassHealth and they couldn’t give me a status update. Can you tell me if it was received or approved?

— Status-Check Sam"

Dear Status-Check Sam,

The Insurance Resource Center can provide the Premium Assistance application and explain how to complete it — but once it’s submitted, status updates must come directly from the MassHealth Premium Assistance team.
Processing the application typically takes 30–60 days. To help avoid delays, it’s a good idea to follow up with the Premium Assistance group a few days after submitting the application to make sure they received everything they need to make a determination. A quick follow-up call can make a big difference!

Premium Assistance Unit Contact Info:
🕐 Hours
• Mon–Tue: 8:00am–7:00pm (evenings often have shorter wait times!)
• Wed–Fri: 8:00am–5:00pm
📞 Phone: (800) 862-4840
📠 Fax: (617) 451-1332
📧 Email: MassPremAssistance@accenture.com
📬 Mail: 519 Somerville Ave #372, Somerville, MA 02143

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.

19/02/2026

ASK THE INSURANCE GURU:

"Dear Guru,

What’s the highest deductible my health plan can have and still qualify for MassHealth Premium Assistance? I heard it used to be $4,000 — did that change?"

Yes — the limits to the deductibles and out-of-pocket maximums for both individuals and families were updated starting 1/1/2026.

To qualify for MassHealth Premium Assistance:
• The in-network individual deductible must be $3,200 or less and the family deductible must be $6,400 or less
• The in-network individual out-of-pocket max must be $10,150 or less and the family out-of-pocket max must be $20,300 or less

If you’d like more details about MassHealth Premium Assistance, check out the updated fact sheet here:
https://massairc.org/wp-content/uploads/2025/12/2026-MassHealth-Premium-Assistance-.pdf-1.pdf

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.

17/02/2026

17/02/2026

https://umassmed.zoom.us/meeting/register/u6YUH74EQvWeg1JlfLiYow

12/02/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My daughter was approved for MassHealth CommonHealth and I received a premium bill. I also applied for Premium Assistance—do I still need to pay the invoice?

Thanks for your help!

Sincerely,
— A PA-tient Parent"

Hi PA-tient Parent!

Great question (and one we hear a lot).

Yes—until Premium Assistance (PA) is officially approved and applied, you’re still responsible for paying the MassHealth CommonHealth premium. MassHealth will continue to send monthly bills, and if premiums go unpaid for 60 days or more, coverage could be terminated.

Because the timing between applications can get tricky, we recommend contacting MassHealth Premium Billing if you have questions about your bill:
• 617-798-6827 (English)
• 617-798-6838 (Spanish)

If you want to check the status of your Premium Assistance application, you can call: 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.

12/02/2026

🎉 Joey’s Fund applications are OPEN!

Families across New England who have a loved one with an autism diagnosis can apply for financial assistance to help access meaningful supports and opportunities.
Funds may be used for things like:
• Camp tuition
• Recreational activities
• Therapies
• Safety equipment
…and more!

🗓 Apply by March 5, 2026 at 5:00 PM
📣 Award announcements: Late April 2026

Learn more & apply here:
https://flutiefoundation.org/helping-families/direct-financial-support/joeys-fund-hope-fund/

🌟 Applications are now OPEN for Joey’s Fund | Hope Fund, our Direct Family Support Grant!

Joey’s Fund and the Hope Fund exist to help families break through financial barriers and access the resources their loved ones with autism need to thrive and live life to the fullest.

From essential services and support, to classes, camps, and more, these grants are designed to meet families where they are and provide meaningful, life-enhancing assistance.

💙 Learn more about eligibility and submit your application:
https://flutiefoundation.org/helping-families/direct-financial-support/joeys-fund-hope-fund

Applications close March 5th at 5 PM ET.

05/02/2026

ASK THE INSURANCE GURU:

"Hi Guru,

My husband recently retired, and we received confirmation that our son, who had been on SSI, will now be receiving SSDI. Will this impact our son’s health insurance? His primary insurance is through my employer, with MassHealth Standard as secondary. What changes can we expect?

Transition Guardian"

Hi Transition Guardian,

What I can tell you is that nothing will change right away. Your son will continue to have your employer-sponsored insurance as his primary coverage and MassHealth as secondary. You will most likely receive a request from MassHealth for additional information to maintain his MassHealth coverage. You can always call the IRC for guidance on any MassHealth application you receive.

Another thing to keep in mind is that after receiving SSDI for 24 months, your son will automatically be enrolled in Medicare. If your employer-sponsored insurance is from a large employer (20 or more employees), then your plan will remain primary, Medicare will be secondary, and MassHealth will be tertiary.

Generally, once Medicare is issued, families assess whether they should maintain private coverage for their loved one. You will want to confirm whether your son’s providers accept Medicare and MassHealth. If he can continue seeing his providers with Medicare and MassHealth, there may no longer be a need to maintain private insurance.

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.

03/02/2026

https://umassmed.zoom.us/meeting/register/yOBQQD-1SDWVFP2fqymFwg