Often, we will meet with potential clients who tell us that they “need to do Medicare planning” to protect their assets for their children should they need to enter a nursing home in the future. We, however, know that they are talking about “Medicaid” planning. (FYI, the Medicaid program in Massachusetts is also known as “MassHealth”).
Medicare and Medicaid, although both government health insurance programs, are quite different in the benefits they provide. Following is a short explanation of the differences:
Medicare
- Federal health insurance program for elders 65 and over, plus
- Younger people with certain disabilities or who have received SSDI benefits for 24 months or more, and
- Children or surviving spouses of at least age 50 of an SSDI recipient
- Pays for short-term rehab stays (which can occur in a nursing home for potentially up to 100 days, with a daily co-pay after day 20
- Does not pay for long-term stays in a nursing home (called ‘custodial care’)
Medicaid (known as MassHealth in Massachusetts)
- Federal insurance program implemented differently by each state, eligibility rules may differ by state
- Different types of Medicaid programs such as MassHealth Standard or CommonHealth, depending on need, income and sometimes assets
- Can cover Seniors age 65 and over, disabled or medically needy younger people, children and non-disabled, low-income recipients
- $2,000 asset limit once the member reaches age 65
- Only insurance program that pays for long-term stays in a nursing home if the applicant meets medical and financial eligibility requirements:
- $2,000 limit of countable assets for the application at age 65 (potentially younger if in a facility)
- $157,920 of countable assets for the applicant’s spouse at home (yearly increases)
Know that when the issue is government benefits to pay for long-term nursing home care, the program needed is Medicaid (“MassHealth”). Be aware that there are expected changes over the next three years to the Medicaid long-term care eligibility process due to the recent enactment of the One Big Beautiful Bill Act. Any member of our Trusts & Estates group would be happy to answer any questions you might have.
