You Cannot Rely On Medicare Or Nursing Home Care Coverage In Massachusetts

Medicare is an important public health program. It helps to ensure that senior citizens are able to access the care that they need. However, Medicare will generally not pay for nursing home care. The program only offers limited, short-term nursing home care coverage. Medicaid is the public program for nursing home costs. The difference matters. Here, our Norwood elder law attorney explains the key things to know about Medicare, Medicaid, and long-term care costs in Massachusetts.

Know How Medicare Works: Very Limited Nursing Home Coverage

Medicare Part A may cover care in a skilled nursing facility, but only under extremely strict conditions that do not involve long-term care, such as inpatient rehabilitation (rehab) if it is deemed medically necessary. To start, the patient must have had a qualifying inpatient hospital stay of at least three consecutive days. Notably, observation status does not count. Second, nursing facility care must be medically necessary and skilled in nature, such as daily physical therapy, wound care, or intravenous medication administration.

The Only Medicare Nursing Home Benefit is for Short-Term Care

Even when these criteria are met, Medicare coverage is temporary. Medicare may pay for up to 100 days of skilled nursing care per benefit period. The first 20 days are typically covered in full. From days 21 through 100, the patient must pay a significant daily coinsurance amount. Once skilled care ends, or the 100-day limit is reached, Medicare coverage stops entirely. That is it.

Key Point: Relying on Medicare for nursing home coverage is a mistake. The program does not provide the support that families need. 

Medicaid is the Primary Public Payor for Nursing Home Care in Massachusetts 

It is Medicaid, not Medicare, that is the public program that pays for long-term nursing home care. In Massachusetts, Medicaid is administered through MassHealth. To qualify, an applicant must meet strict income and asset limits. These limits apply differently to single individuals and married couples, and improper planning can lead to denial or delay of benefits. 

Medicaid has a Five Year Lookback Period in Massachusetts 

MassHealth also imposes a five-year lookback period. Asset transfers made for less than fair market value during that period can result in a penalty period of ineligibility. Timing, documentation, and legal structuring are critical for Medicaid eligibility. If you can set up a trust at least five years before any actual need, your assets will be best protected from long term care costs. 

Why the Distinction Matters for Planning for Long Term Care in Massachusetts 

The difference between Medicare and Medicaid drives nearly all long-term care planning decisions. Medicare offers short-term medical support. Medicaid provides long-term financial coverage but only after eligibility requirements are satisfied. Families who assume Medicare will cover nursing home costs often delay planning until a crisis occurs.

Here is the big issue: Nursing home care is expensive. According to the Massachusetts Division of Insurance, the average annual cost of nursing home care is $132,000.  We typically see, however, that the cost of a nursing home costs between $16,500 and $21,000 per month or $198,000 to $252,000 per year in the Greater Boston area.  That could drain your life savings very quickly. Medicare is not going to help. Medicaid or MassHealth might. However, there are strict financial eligibility requirements. You need a proper plan in order to qualify for Medicaid for nursing home care without being forced to spend down a large share of your assets. 

Get Help From a Norwood Elder Law Attorney for Long Term Care Planning Today

At Fisher Law LLC, our Norwood elder law attorney has the knowledge and experience to help people and families plan for long term care costs. If you have any questions about Medicare or Medicaid, we can help. Please do not hesitate to contact us today for a fully confidential case review. We provide long term care services in Norwood and throughout the Greater Boston area.

Source:

mass.gov/info-details/what-is-long-term-care-insurance