Does Medicare Cover Nursing Homes In Massachusetts?
Nursing home care is expensive. The Massachusetts Division of Insurance explains that the average annual cost in the Commonwealth can run into the six figures. It is a big challenge for many families because Medicare does not cover nursing home care. Instead, Medicaid, called MassHealth in Massachusetts, is the public program that can be used for support. Medicaid is strictly means tested. Here, our Boston estate planning attorney provides a guide to Medicare and Medicaid in Massachusetts.
Medicare Only Provides Extremely Limited Nursing Home Care Coverage
There is a big myth about Medicare and nursing home care. Too many people and families think that they can rely on Medicare during their time of need. Unfortunately, that is simply not the case. Medicare coverage for nursing home care is extremely limited in Massachusetts and often misunderstood. Medicare Part A may cover a short-term stay in a skilled nursing facility, but only if strict conditions are met. A person must first have a qualifying inpatient hospital stay of at least three consecutive days, not including observation status. The nursing facility admission must be medically necessary and related to the condition treated in the hospital. Even then, Medicare only covers up to 100 days per benefit period, and full coverage applies only to the first 20 days.
Note: Medicare does not cover custodial care. Custodial care includes assistance with activities of daily living such as bathing, dressing, eating, toileting, and supervision due to cognitive decline. That is the type of care most long-term nursing home residents require. At that point, families must either pay privately or qualify for Medicaid.
What to Know About Medicaid Coverage for Nursing Homes in Massachusetts
In Massachusetts, Medicaid operates under the MassHealth program. MassHealth is the primary payer for long-term nursing home care once Medicare coverage ends or is unavailable. Unlike Medicare, MassHealth does cover custodial nursing home care, but eligibility is tightly regulated. Applicants must meet strict income and asset limits. For a single individual, countable assets are generally capped at a modest amount, while most income must be contributed toward the cost of care through a patient-paid amount.
For married couples, the rules are more complex. Massachusetts applies spousal impoverishment protections that allow the healthy spouse, known as the community spouse, to retain a portion of the couple’s assets and income. Even so, improper transfers or excess resources can trigger periods of ineligibility. Massachusetts enforces a five-year lookback period for asset transfers, meaning gifts or below-market transfers made within five years of applying for MassHealth can result in significant penalty periods during which benefits are denied.
Why Advance Planning Matters in Massachusetts
Because Medicare does not cover long-term nursing home care and MassHealth eligibility is means tested, advance estate planning is often essential. Families who wait until a nursing home admission is imminent frequently discover that their assets must be spent down rapidly or that past transfers have created penalties. With proper planning, however, Massachusetts residents may be able to preserve assets for a spouse or family while still qualifying for MassHealth when care is needed. A top-tier Boston long-term care planning lawyer can help you and your family put the right structure in place.
Call Our Boston Long Term Care Planning Attorney Today
At Fisher Law LLC, our Boston long term care planning lawyer is standing by, ready to protect your rights and your interests. A proactive approach can make a big difference. If you have any questions about Medicare or Medicaid, please do not hesitate to contact us today. We provide long term care services throughout the Greater Boston area.
Source:
mass.gov/info-details/what-is-long-term-care-insurance
