Insurance Resource Center for Autism and Behavioral Health

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Insurance Resource Center for Autism and Behavioral Health The Insurance Resource Center for Autism and Behavioral Health is a program of The Shriver Center, a division of UMass Chan Medical School

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ion such as yours or anyone else’s account number, address, phone number, email address, or social security number. The Autism Insurance Resource Center is not responsible for views expressed other than our own. The Autism Insurance Resource Center's Social Media Sites are moderated by Autism Insurance Resource Center employees. We will make every effort to respond in a timely manner; however, we cannot guarantee that we'll reply to every comment.

ASK THE INSURANCE GURU:"Dear Guru, My son recently became eligible for Medicare. He has MassHealth Standard as well. I ...
28/05/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My son recently became eligible for Medicare. He has MassHealth Standard as well.

I received a letter that his Social Security will be reduced by $202.50 every month to cover the Medicare Part B premium.
I thought MassHealth would pay for this premium?

What should I do?

Monica"

Dear Monica,

Don’t worry! MassHealth will pay for your son’s Medicare Part B premium.
It’s complicated, but your son’s eligibility is run twice a month. When his eligibility was run in the beginning of the month, it triggered this letter. However, when his eligibility is re-run in the middle of the month, the MassHealth coverage will be “connected” to his Medicare. This triggers MassHealth to pay for the Part B premium.

Sometimes it takes the system 2-3 months to “catch up” with the Medicare eligibility.

Confusing? Yes, but don’t worry.

MassHealth will also pay retro if this happens with your son’s case.

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.

ASK THE INSURANCE GURU:"Dear Guru,I recently applied for MassHealth coverage for my child and was relieved to receive an...
14/05/2026

ASK THE INSURANCE GURU:

"Dear Guru,

I recently applied for MassHealth coverage for my child and was relieved to receive an approval letter. However, the letter says the approval is only for a limited time, which worried me. I thought that once my child was approved, they would be able to keep their coverage.

Does this mean their coverage is going to end soon?"

This is a common concern, and fortunately, the “limited time” language does not necessarily mean your child will lose coverage. In the same section of the approval letter that mentions the limited approval period, it goes on to explain that MassHealth will be sending a separate request for additional information. The most common request is for proof of income, although it could be for other items as well. The approval letter may also show a monthly premium amount, but that amount can change after MassHealth reviews the income documentation if the request is for proof of income.

The follow-up request will also include a specific deadline for submitting the information. It’s very important to respond by that deadline, because if MassHealth does not receive the requested documents in time, coverage may be terminated. If you have not received the separate request for information, it’s a good idea to call MassHealth directly to confirm what is needed and discuss your options for submitting it. Responding promptly will help ensure your child’s coverage continues without interruption.

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.

ASK THE INSURANCE GURU:"Dear Guru,My son is enrolled in MassHealth CommonHealth, and we do not receive premium assistanc...
07/05/2026

ASK THE INSURANCE GURU:

"Dear Guru,

My son is enrolled in MassHealth CommonHealth, and we do not receive premium assistance. I recently got a notice that it was time to renew our coverage, so I completed the renewal over the phone with a MassHealth representative.

Nothing about our income or household has changed, but when I received the approval letter, the monthly premium listed was higher than what we’ve been paying. I’m confused about why our premium increased if nothing else changed.

Did I do something wrong, or is this a mistake?"

You did everything right, and this situation is understandably confusing. What you’re seeing is likely due to a recent statewide change rather than anything specific to your application. As of January 1, 2026, MassHealth implemented a 10 percent increase in premiums for CommonHealth members. However, this increase is not applied to everyone at the same time.

Current members will begin seeing the higher premium only after they complete their next renewal. Since you recently renewed your coverage, your case has now been updated to reflect the new premium rates, even though your income and household information stayed the same. That’s why your approval notice shows a higher amount than before.

If you have questions about the exact premium calculation or want to confirm the amount, you can contact MassHealth customer service. But in most cases like yours, the increase is simply the result of this scheduled premium adjustment.

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.

ASK THE INSURANCE GURU:Dear Guru,My daughter was recently diagnosed with autism, and her ABA provider suggested I apply ...
30/04/2026

ASK THE INSURANCE GURU:

Dear Guru,

My daughter was recently diagnosed with autism, and her ABA provider suggested I apply for MassHealth as secondary insurance to our Harvard Pilgrim plan. I completed the application, but we were denied—and I’m not sure why, especially given her diagnosis. I even noted her autism diagnosis in the “reasonable accommodations” section.
I’ve talked to other parents of children with autism who do have MassHealth, so now I’m wondering… what did I miss?

– Paperwork Patty

Great question—and you’re definitely not alone here.

MassHealth eligibility is usually based on income, but when a disability is involved, a different pathway for coverage may apply. The key step that often gets missed is selecting the “disability indicator” on the application. This tells MassHealth that your child has a condition expected to last more than 12 months and triggers an additional step: the Disability Supplement.
Many families are initially denied based on income, but that’s not always the end of the process. If you’re over the income limits and the applicant has a disability, the next step is to complete the Disability Supplement. After you submit it, Disability Evaluation Services will review the application. If your child meets the disability criteria, she will qualify for MassHealth CommonHealth—even if your income exceeds the standard guidelines (this coverage will involve a monthly premium that is based on family size and income).

Also, the “reasonable accommodations” section is often misunderstood—it’s only for requesting communication supports (like large print or interpreter services), not for determining eligibility.

For step-by-step help applying for CommonHealth, check out this helpful guide:https://massairc.org/wp-content/uploads/2025/03/CommonHealth.pdf

Hope this helps clear things up!

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.

ASK THE INSURANCE GURU:"Hi Guru,My daughter has MassHealth CommonHealth with Premium Assistance based on the family heal...
23/04/2026

ASK THE INSURANCE GURU:

"Hi Guru,

My daughter has MassHealth CommonHealth with Premium Assistance based on the family health insurance we receive through my employer. I am in Open Enrollment right now 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 $6400 and the out-of-pocket max is no more than $20,300.

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 2026-2027 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.

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.

ASK THE INSURANCE GURU:"Dear Guru:My child’s Early Intervention provider suggested that we should seek an autism evaluat...
17/04/2026

ASK THE INSURANCE GURU:

"Dear Guru:

My child’s Early Intervention provider suggested that we should seek an autism evaluation for my toddler. I called a few places, but they all have long wait lists, and we are hoping to have him seen sooner. Do you have other suggestions for where we might go?

Concerned Mom"

Dear Concerned Mom:

Thank you for writing to us. Long wait times for evaluations are a common issue and can delay access to care. But there is a new resource in Massachusetts, the MCPAP Early Autism Diagnosis Project, that can help.

The MCPAP Early Autism Diagnosis Project is available to all children in Massachusetts under 6 years of age. MCPAP partners an autism diagnosis specialist with your primary care clinician to assess your child, and, if they are determined to have autism, will provide a diagnosis and referral letter.

Ask your primary care doctor or nurse practitioner to refer you to their MCPAP (Massachusetts Child Psychiatry Access Program) site. MCPAP will call you back to begin the evaluation, usually within ONE business day. In addition to the evaluation, you will be assisted by a family partner to support you after the diagnosis and help connect you to services and resources.

I hope this is helpful. If you have questions or need further information, my colleagues at the Insurance Resource Center would be happy to assist. If you have questions and/or need more information, please reach out to the Insurance Resource Center at 774-455-4056 or email them at [email protected]

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.

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