Older woman in a nursing home in the care of her nurse.

MassHealth, Medicaid, and Medicare – Who Pays for Nursing Home Care?

When our elder law care team meets with clients, our clients often confuse the words “Medicare,” “Medicaid,” and “MassHealth.” Understanding the differences between government programs can be confusing. When it’s time for a loved one to receive medical care in a nursing home, many families are left wondering which government program can help pay for their loved one’s care. Medicaid and Medicare sound similar, but these two government programs offer different benefits. Understanding the two government programs can be incredibly helpful in elder care planning. 

MassHealth Is Massachusetts’ Medicaid Program

MassHealth and Medicaid are in the same programs. In Massachusetts, we call our state Medicaid program MassHealth. Some states call their Medicaid program only “Medicaid,” but our state created a unique name to identify the program, MassHealth. 

The Difference Between MassHealth (Medicaid) and Medicare

Both Medicaid and Medicare are federal health insurance programs created in 1965 under President Lyndon B. Johnson’s administration. The goal of Medicaid is to aid low-income individuals who need health insurance. On the other hand, Medicare seeks to provide benefits for the disabled and elderly. When it comes to nursing home care, however, Medicaid (MassHealth) may cover long-term care. If feasible for your loved one, remaining at home with Community MasHealth benefits may also be an option.  

On the other hand, Medicare usually only covers the cost of 90 days of short term care after a qualifying emergency or medical issue. Medicare will cover some rehabilitation costs after a hospital stay or short term acute care. If your loved one needs long-term care in a nursing home and they meet the qualification criteria, you will need to apply for Medicaid (MassHealth). 

Medicaid Provides Health Care to Low-Income People of Any Age

Medicaid is a federal program, and each state administers its own Medicaid plan, which Massachusetts calls MassHealth. Medicaid eligibility is based on a person’s income as well as other factors. Medicaid covers long-term care expenses for those who are living in a nursing home.

Medicaid (MassHealth) Covers Nursing Home Care Costs

Depending on the level of care your loved one receives, nursing homes can cost as much as $15,000 per month. Qualifying for Medicaid is essential for most elders in Massachusetts. If you or your loved one need to enter a nursing home, qualifying for MassHealth long-term care benefits can help you tremendously. MassHealth provides long term care benefits that will pay for nursing home care. 

Qualifying for MassHealth is challenging, however. Only individuals who meet the income and asset qualifications will become eligible for Medicaid. MassHealth will look at your Modified Adjusted Gross Income (MAGI) as well as who is living with you in your household to determine whether you make too much money to qualify for MassHealth. 

Will MassHealth Cover All Nursing Home Care Costs?

Most of the time, MassHealth will pay for almost all of the cost of nursing home care. Those receiving Medicaid may need to pay a small copay depending on the coverage plan. In some cases, MassHealth can recover assets from the recipient’s estate after the recipient passes away. MassHealth does have the authority to place a lien against the recipient’s home. When the recipient has a surviving spouse or a disabled or blind child who resides in the home, MassHealth typically will not place a lien on the family home. 

Medicare does not cover long-term care. In some cases, it is possible to qualify for dual Medicaid and Medicare coverage. When this happens, Medicaid and Medicare work together to cover health care coverage and lower costs for the recipient. Depending on the Medicare plan, the recipient may need to pay copays and deductibles for treatment and medication. 

Our Elder Law Team Can Help You Plan for Nursing Home Care

Many families worry about how to pay for nursing home care for their loved ones. At Surprenant & Beneski, PC, our certified elder law lawyers can help plan for MassHealth benefits. If your loved one is already in need of nursing home care, we can help you apply for MassHealth benefits now. Contact our Southeastern Massachusetts elder law team today to schedule your initial consultation.