Planning for Life

Premium Assistance from MassHealth for Private Health Insurance

Posted by Karen B. Mariscal on November 10, 2014

It seems that very few parents of intellectually disabled adult children aged 18-26 know about the MassHealth Standard/CommonHealth Premium Assistance Program, which can provide meaningful financial assistance to those who qualify.

If your child is disabled and on MassHealth (which happens automatically if she receives SSI benefits), and you are continuing to cover her on your health insurance plan at work, you may be able to receive reimbursement for the health insurance premiums that you pay -- not just for your child, but for your entire family.  

In order to be eligible for Premium Assistance, you must:

- Have at least one family member on MassHealth Standard or MassHealth CommonHealth;
- Work for an employer that provides employer-sponsored health insurance benefits that are approved by MassHealth; and
- Pay the premiums for your private health insurance out-of-pocket (if your employer is paying for you, you won’t get reimbursed, but you can get reimbursed for the portion of the premiums you do pay).

There are other restrictions, so the best way to find out if you qualify is to apply.  (Note that family income is not taken into account.)  The size of the reimbursement is based on many variables, but it can be up to $66 0a month. You will either get a monthly check sent to you, or your employer will reduce your payroll deduction for health insurance. Your child will receive whatever health care benefits your private health insurance offers. 

In order to apply, call MassHealth at 1-800-862-4840.  (MassHealth does not post the application on the web; you have to call them.)  Explain that you are calling about the MassHealth Standard/CommonHealth Premium Assistance Program for a family member with a disability.  Good luck.  This is not retroactive, so get going! Don't leave up top to  $7,920 on the table.

Topics: MassHealth

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