My child has ASD and is on my family policy. What happens when they turn 26?
How do I keep them on my policy after they turn 26?
Does this just apply to people with ASD?
What documentation is required?
What if my child is already older?
Does ARICA cover autism treatments for adults?
My child is receiving MassHealth. Can they also have private insurance?
Will MassHealth provide Premium Assistance for private insurance?
What happens when a parent gets Medicare?
- Have any questions? E-mail us at AIRC@umassmed.edu
- Read FAQs about ARICA
- Read disabilityinfo.org FAQs
My child has ASD and is on my family policy. What happens when they turn 26?
All children can remain under a parent’s policy until age 26. Disabled children can often remain on a parent’s policy after age 26.
How do I keep them on my policy after they turn 26?
Parents need to apply to their employer or insurer for this coverage as each company has different requirements. It is recommended that parents notify their employer or insurer that their child is disabled and will need to remain on the policy as early as possible, (ideally several years before they are going to turn 26). Waiting until you receive a notice that your child will be terminated from your policy, which often arrives shortly before their 26th birthday, is not advised.
Does this just apply to people with ASD?
No, this is for all disabled children. If a person doesn’t have a formal ASD diagnosis, another diagnosis such as depression, or anxiety disorder could be used.
What documentation is required?
Insurers all have different requirements, which is why we recommend applying as early as possible. At a minimum, the insurer will likely require documentation from a medical professional, but depending on the insurer, or the individual case, they may need more extensive information. Also, some insurers may only approve the coverage for a limited period of time, and require a new application or review of the disability determination to continue coverage.
My child has a job that provides insurance. If they lose their job, can I put them back to my policy?
Only if they are still under 26. If a child is not on a parent’s policy when they turn 26, they are not usually able to be re-enrolled, regardless of disability. If your child is disabled, and you are concerned that this could happen, it might be helpful to keep them on your policy, regardless of their current access to employer insurance.
What if my child is already older?
Some employers/insurers may still allow the disabled child over 26 to be covered. We recommend checking with your employer or insurer.
Does ARICA cover autism treatments for adults?
Yes. ARICA, the law requiring private, state-regulated, insurance policies to cover medically necessary treatment for individuals with autism, has no age limitation. For more information, refer to our FAQ’s on ARICA.
Can I purchase a policy from the Health Connector that will provide access to ARICA benefits for my child?
Yes. Note- the Health Connector offers many policies. Only “Unsubsidized Qualified Health Plans” sold through the Connector during their open enrollment periods are subject to ARICA. If you have additional questions regarding Connector Plans and ARICA, please contact us.
My child is receiving MassHealth. Can they also have private insurance?
Yes, an adult child who receives MassHealth can also have private insurance.
If my child has MassHealth and private insurance, how will I know what plan is the primary plan and what is the secondary plan?
In general, the private insurance is the primary plan, and MassHealth is the secondary plan.
Will MassHealth provide Premium Assistance for private insurance?
If the adult child receives MassHealth and you purchase a policy from the Health Connector, it is only eligible for Premium Assistance if they are under 21. If your child receives MassHealth and is also on your employer’s policy, they will be eligible for Premium Assistance with no age limit.
What happens when a parent gets Medicare?
When a parent transitions to Medicare, they generally don’t have private insurance anymore. If this is of concern, we recommend seeking further assistance on this issue.
- If your disabled adult child is under 26 and covered on your policy, you should contact your insurer or employer and inquire about what specific steps you need to take in order to keep them on your policy after they turn 26.
- If your disabled adult child is under 26 and not covered on your policy, but you think they might need this coverage, consider adding them back to your policy now.
- If your disabled adult child is over 26, contact your employer or insurer, and ask whether they might still allow you to cover them under your policy.