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Norwood Estate Planning Lawyer > Blog > Long-Term Care (LTC) Planning > Long-Term Care Planning In Massachusetts: Does Medicare Cover Nursing Homes?

Long-Term Care Planning In Massachusetts: Does Medicare Cover Nursing Homes?


Senior Living reports that the average monthly cost of a private room in a nursing home in Massachusetts now exceeds $14,300 per month. While that may be the average, the most common cost is $550 per day or $16,500 per month.   Either figure is  an extraordinarily high figure. This raises an important question: Does Medicare cover nursing homes? With limited exceptions, the answer is “no”—you cannot rely on Medicare for nursing home needs. Instead, Medicaid is the public program that provides support for long-term nursing home needs. Here, our Boston long term care planning lawyer explains why the distinction matters and what you can do to prepare your estate.

Background: Unlike Medicare, Medicaid is Strictly Means-Tested 

Medicaid and Medicare are both government programs that help people pay for healthcare. While they often get mentioned together, they are very different programs. Medicare is generally for people who are 65 or older—and it does not consider your income or assets. On the other hand, Medicaid is a program that helps low-income individuals of any age. To qualify for most Medicaid programs, your income and assets must be below certain levels.  Eligibility for skilled care in a nursing facility has an asset test , but income is only considered after qualification and generally with regard to how much is paid to the facility.   This is known as “means-testing.”

Why does this matter? When it comes to long-term care—like staying in a nursing home—Medicare offers extremely limited coverage. On the other hand, Medicaid can provide significant coverage for these costs. However, it will only do so if you meet the strict financial eligibility requirements. 

A Person May Be Required to “Spend Down” Assets Before Medicaid Covers a Nursing Home 

One of the most important aspects of Medicaid eligibility is the “spend down” process. If you have too many assets or too much money, you might have to spend some of these funds before Medicaid will step in to cover your nursing home costs. Essentially, you must prove that your financial resources are below a certain level—which might involve paying for medical bills, debts, or even the initial nursing home care costs out-of-pocket until your assets fall within Medicaid’s eligibility limits. Given the high-cost of nursing home care, a person’s life-savings can quickly be drained. 

You Can Preserve Your Assets With a Comprehensive Long-Term Care Plan 

There is good news: A comprehensive estate plan that considers long-term care needs can help to protect your assets and preserve your wealth. To avoid the harsh impact of the spend-down requirement of Medicaid, many people turn to long-term care planning strategies. One common method is setting up trusts. A trust is a legal arrangement where your assets are managed by a trustee for the benefit of you or your heirs.

A Medicaid-compliant trust effectively takes the assets out of your name and allows you to qualify for coverage without being forced to spend down. However, you need to be aware of the five-year lookback rule. Medicaid will look at any assets you transferred in the five years before applying for coverage. If they find you’ve transferred assets to qualify for Medicaid in that five-year period they may penalize you by delaying your eligibility. A trust should be set up at least five years before long-term care needs.

Contact Our Boston Long Term Care Planning Attorney Today

At Fisher Law LLC, our Boston estate planning lawyers have extensive experience handling long-term care planning issues and applying for the Medicaid benefit in Massachusetts (called, MassHealth) If you have any questions about Medicaid or MassHealth planning, please do not hesitate to contact us today for a confidential initial consultation. We provide long-term care planning services throughout the Greater Boston area, including in Norwood, Westwood, Dedham, Canton, Stoughton, and Walpole.



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