Senior citizens typically rely on Medicare coverage for basic health care expenses. Medicare can pay for routine medical treatment and emergency procedures. However, there are gaps in Medicare coverage, particularly when considering the long-term support needs of older adults.
In cases where people need in-home nursing support or a room in a nursing home, Medicare cannot cover their costs. Older adults may need to apply for MassHealth benefits to cover the cost of long-term care. Older adults and family members supporting aging individuals need to understand MassHealth in order to navigate the system effectively.
MassHealth is a needs-based program
MassHealth is the Massachusetts Medicaid program. Unlike Medicare, which is an earned benefit provided to retired professionals and their dependent spouses, MassHealth is a needs-based program. Only those without adequate income and resources qualify for MassHealth benefits.
When people apply for coverage, the state looks at their countable assets and their current income. There is also a review of their financial conduct that goes back five years. Any significant transfers or large gifts made in the years prior to an application could lead to a penalty.
Older adults who no longer have much income or many resources of their own may have to pay for their own medical care for a certain number of months before MassHealth covers anything. Planning well in advance is the only way of ensuring that an older adult can obtain MassHealth benefits quickly when they need them.
Advance planning also reduces the likelihood of estate recovery efforts in the future. Federal regulations require that state Medicaid programs seek to recoup long-term care benefits paid on behalf of older adults. MassHealth may file a claim in probate court seeking reimbursement for the full value of the benefits received. Even assets that do not prevent individuals from qualifying for MassHealth, including the equity in their primary residences, can be vulnerable to recovery efforts after they die.
Older adults and their family members may need to make an effort to plan for MassHealth benefits ahead of time in case the older adult eventually needs intensive support as they age. Proper planning before MassHealth benefits become necessary can speed up the qualification process and decrease the negative impact that seeking benefits can have on an applicant and their family members.