Can I use Medicaid or Medicare to pay for nursing home care?

On Behalf of | May 25, 2023 | Nursing Home Planning

Some people can pay for nursing home care through private funds, but many do not have enough savings to afford nursing home care. Instead, they plan on relying on government benefits if eligible to pay for nursing home care.

The government benefits available to pay for nursing home care include Medicare and Medicaid/MassHealth. But Massachusetts residents should know that these programs cover different services and have different eligibility requirements.

What services does Medicare cover?

Medicare is run by the federal government. Medicare might be an option for those who are age 65 or older and qualify for Social Security benefits.

Medicare only covers short-term nursing home care. If the nursing home stay lasts from one to 20 days, Medicare will cover a pre-set amount in a semi-private room.

If a person needs to stay in a nursing home for more than 20 days, Medicare will cover a stay of up to 100 days, but it will require a co-pay.

Coverage will end if a person no longer needs nursing home care. If a person needs more than 100 days of care in a nursing home, they may need to turn to Medicaid/MassHealth for coverage.

What services does Medicaid/MassHealth cover?

Medicaid is a federal program that is run by the states. In Massachusetts, it is referred to as MassHealth. MassHealth can be used to pay for a nursing home stay that lasts longer than what is paid for by Medicare.

A person must be eligible for MassHealth benefits to use them to pay for nursing home care. MassHealth eligibility depends on how much they have in countable assets, and whether nursing home care is deemed necessary.

MassHealth is not always entirely free. Some people may need to pay for some aspects of their stay. For example, while residency fees might be covered by MassHealth, personal needs such as clothing, favorite snacks or toiletries might not be covered.

It can be complicated to parse out what Medicare covers and what MassHealth covers and who is eligible for benefits. Fortunately, resources are available to those who want to learn more about these programs, what they pay for and who qualifies for benefits.