How can I pay for nursing home care? FAQs answered

A large majority of people over 65 will need long-term care, but few are prepared for the cost. Here are some answers to frequently asked questions regarding how to pay for nursing home care in Massachusetts

What options are available to pay for long-term care?

The average nursing home care costs upwards of $75,000 per year in Massachusetts for a semi-private room; in the Boston area, the costs are significantly greater and average upwards of six figures. Paying this cost out-of-pocket is not feasible for most families. There are two options when planning for the cost of nursing home care if footing the bill is not an option. The first is long-term care insurance. While long-term care insurance can be very beneficial, it is also expensive. And not every long-term care insurance plan will cover all medical costs associated with long-term care.

The other option is MassHealth, which will pay most nursing home costs for eligible Massachusetts residents. However, in order to qualify for MassHealth, the person receiving benefits cannot have a monthly personal allowance of more than $72.80 per month. In addition, the MassHealth recipient cannot have personal assets in excess of a certain amount.

I haven't planned ahead and now I need to pay for a nursing home. What can I do?

Life gets busy, and few people anticipate a devastating medical condition or illness. Many people are in your boat, scrambling to pay for nursing home care without bankrupting the family. Fortunately, there are options, but these must be taken carefully.

Medicare will pay for 100 percent of care during the first 20 days if the beneficiary is hospitalized for more than three days. After 20 days, the beneficiary must pay a daily co-payment. Medicare only covers 100 days of skilled long-term care.

After 100 days, the only public benefit available to pay for care is MassHealth. Applying for MassHealth requires knowing when to file and what eligibility requirements there are. It also requires knowledge of what MassHealth administrators will look at when determining eligibility. For example, a parent in a nursing home cannot gift all assets to a child without incurring penalties, which effectively delay the ability to obtain MassHealth coverage.

I (or my parent) worked hard over a lifetime to save money. Can I keep any of it?

The short answer is yes. However, what is exempt from MassHealth eligibility requirements can be a complex and nuanced area of the law. In addition, for those who pre-plan, there are ways to reduce an estate without incurring penalties, so long as those actions are taken carefully.

Where can I get help?

The Center for Elder Law & Estate Planning has years of experience helping individuals plan for long-term care needs. Individuals looking to secure an inheritance for their children or who need to pay for a parent's nursing care should contact attorney John A. Gianino to discuss their legal and financial options.

Keywords: Long-term care, nursing home care, FAQs, Medicaid, Medicaid eligibility, gift transfers.