Understanding the differences between Medicare, Medicaid and MassHealth

On Behalf of | Nov 9, 2023 | elder law, Estate Planning, MassHealth, Medicaid/Medicare

Medicare, Medicaid and MassHealth are all extremely important programs that can help Massachusetts residents with their medical needs. It’s common to hear their names tossed around in the same conversation, and it can be easy to get them confused with each other However, the three programs differ in terms of their eligibility requirements, what they cover and other important points.

In this blog post, we’ll try to help you make sense of what these programs do and who they are for.


Medicare is a federal program that can pay for medical care, including hospital stays and prescription drugs. It is primarily for people ages 65 and older. To qualify, generally, one must also qualify for Social Security or Railroad Retirement Board benefits. Those who have certain disabilities may qualify early.


Medicaid works as a joint federal-state program to provide health coverage to more than 72 million Americans. Those covered include seniors, people with disabilities, pregnant women, children and more.

To be eligible for Medicaid, an applicant must typically qualify under a test of their income and resources. The government bases this financial test on a system it calls Modified Adjusted Gross Income. The blind and those who have certain disabilities may be eligible without this financial eligibility test.

Federal law requires state programs to cover a long list of services, including inpatient and outpatient hospital care, transportation to medical appointments, laboratory services and more. States are free to add more services to this list in their joint programs.


MassHealth is a Massachusetts program that combines the state’s Medicaid and Children’s Health Insurance Program.

To be eligible, an applicant must be a U.S. citizen and must meet Massachusetts residency requirements as well as the MAGI financial requirements. Eligibility may also be affected by the identities and assets of those who live in their household.

Long-term care

For the purposes of estate planning and elder law it’s important to note that, unlike Medicare, Medicaid and MassHealth can cover nursing home and long-term care services.

The exact type of coverage MassHealth provides for these services may depend on the applicant’s age, their work history and the financial resources of their spouse.

In elder law and estate planning, attorneys often help clients to remain eligible for MassHealth so that they can take advantage of its long-term care benefits even if they otherwise might not satisfy the program’s financial eligibility requirements.