Medicare vs MassHealth: Who Pays for Nursing Home Care in MA?
Nursing home preparation is serious and can get emotional. Nursing home care in Massachusetts can be very expensive. Can you get help? Who pays for nursing home care?
Two names often come up: Medicare and MassHealth. They sound similar, but they work very differently, especially for nursing home costs. Let’s review Medicare vs. MassHealth nursing home care MA in simple terms, so you know what to expect.
What is Medicare?
Medicare is a health insurance program from the federal government. Most people get Medicare when they turn 65. Younger people might get it if they have certain disabilities. Click here if you need help applying for Medicare.
Think of Medicare like regular health insurance, but mainly for older adults. It helps pay for doctor visits, hospital stays, and prescriptions.
Does Medicare Pay for Nursing Home Care?
Sometimes, yes. But usually only for a short time and only for skilled nursing care.
- What is Skilled Nursing Care? This is care you need from specialty nurses or therapists, like physical therapy after surgery or wound care. It’s meant to help you get better, not just help with daily living.
- Hospital Stay Needed: To get Medicare to pay for skilled nursing care, you usually need to have stayed in the hospital as an inpatient for at least 3 days first.
- Short-Term Only: Medicare covers skilled nursing care for a limited time.
Here’s how Medicare coverage usually works for a skilled nursing facility stay in 2025:
| Days | What Medicare Pays | What You Pay (in 2025) |
| Days 1-20 | 100% of approved amount | $0 |
| Days 21-100 | Most of the approved amount | $209.50 per day |
| Day 101+ | Nothing | 100% of costs |
(Source: Official U.S. Government Site for Medicare – Skilled Nursing Facility Care Costs – opens in new tab)
Important: Medicare does not pay for long-term custodial care. Custodial care means help with daily tasks like bathing, dressing, eating, or moving around. If someone needs to live in a nursing home long-term mainly for this type of help, Medicare won’t cover it.
What is MassHealth?
MassHealth is the name for Massachusetts’ Medicaid program. It’s a program run by both the state and the federal government.
MassHealth helps people with lower incomes and limited assets pay for healthcare costs. Assets are things you own, like money or property.
Does MassHealth Pay for Nursing Home Care?
Yes! For people who qualify, MassHealth is often who pays for nursing home care in Massachusetts.
MassHealth does cover long-term custodial care if it’s medically needed. It also covers skilled nursing care. If you meet the requirements, MassHealth can pay for nursing home care for as long as you need it and as long as you’re eligible.
Key Differences: Medicare vs. MassHealth Nursing Home Care MA
Let’s break down the biggest differences:
(Image: Simple comparison graphic showing Medicare short-term arrow vs. MassHealth long-term arrow. Alt text: Graphic comparing Medicare’s short-term skilled nursing coverage vs. MassHealth’s long-term nursing home coverage.)
Type of Care Covered
- Medicare: Pays for short-term skilled nursing care to help you recover after a hospital stay. It does not pay for long-term custodial care.
- MassHealth: Pays for long-term care, including both skilled care and custodial care, if you meet the rules.
How Long Does Coverage Last?
- Medicare: Up to 100 days per benefit period (with copays after day 20), and only if you need skilled care.
- MassHealth: As long as the care is medically necessary and you continue to meet the MassHealth eligibility rules.
Who Qualifies?
- Medicare: Based mostly on age (65+) or disability. For nursing home coverage, you also need that qualifying 3-day inpatient hospital stay. Your income and assets don’t usually affect getting Medicare itself.
- MassHealth: Based on medical need AND strict income and asset limits. This is where it gets complicated for many families.
Here’s a quick look:
| Feature | Medicare | MassHealth (Medicaid in MA) |
| Main Purpose | Health insurance (65+, disabled) | Health assistance (low income/assets) |
| Nursing Home Use | Short-term, skilled care (rehab) | Long-term care (skilled & custodial) |
| Requires Prior Hosp. Stay? | Yes (3 inpatient days) | No (but medical need required) |
| Coverage Limit | Up to 100 days (with copays) per benefit period | As long as medically needed & eligible |
| Income/Asset Based? | No (for basic eligibility) | Yes (strict limits apply) |
MassHealth Eligibility for Nursing Homes: A Quick Look
Getting MassHealth to pay for nursing home care involves meeting complex rules. Brunelle Medicaid specializes in helping families navigate this process, but here are the basics:
- Medical Need: A doctor must say you need the level of care provided in a nursing home.
- Income Limits: For nursing home care, there isn’t a strict monthly income cap. However, almost all your monthly income must be paid to the nursing home. You get to keep a small amount called the Personal Needs Allowance ($72.80 per month in 2025) and may keep money to pay for Medicare premiums or give an allowance to a spouse at home. This is called the “Patient Paid Amount” or “Liability.”
- Asset Limits: This is often the biggest hurdle. MassHealth looks at your “countable assets.”
- Countable Assets: These are things MassHealth looks at, like money in checking and savings accounts, stocks, bonds, and sometimes real estate that isn’t your main home. IRAs are usually countable in Massachusetts.
- Non-Countable Assets: These usually don’t count towards the limit. Examples include your primary home (up to an equity limit of $1,097,000 in 2025 if your spouse or certain others don’t live there), one car, personal belongings, and certain burial funds.
What are the Asset Limits (2025)?
- Single Person: Must have $2,000 or less in countable assets.
- Married Couple (Spouse at Home): The rules are different to help protect the spouse living at home (the “community spouse”). In 2025:
- The person needing nursing home care can have $2,000 in assets.
- The community spouse can keep between $31,584 and $157,920 in assets. The exact amount depends on the couple’s total assets.
(Source: Mass.gov Program Financial Guidelines – opens in new tab)
What is “Spending Down”?
If you have too many countable assets to qualify for MassHealth, you might need to “spend down.” This means using your extra assets to pay for approved costs, like medical bills or the nursing home bill itself, until you reach the MassHealth asset limit.
Warning: Simply giving away money or assets to qualify can cause big problems! MassHealth looks back 5 years at financial transfers. Gifts made during this “look-back period” can lead to a penalty, meaning MassHealth won’t pay for care for a certain amount of time.
How Brunelle Medicaid Can Help
Figuring out Medicare vs. MassHealth nursing home care MA is tough. The MassHealth application and rules, especially the asset rules and spend-down strategies, are very complex. Mistakes can be costly and delay needed care.
At Brunelle Medicaid, we specialize in helping Massachusetts families understand these rules and successfully apply for MassHealth benefits for nursing home care. We know how to navigate the system and help protect assets when possible under the law.
Wrapping Up
Understanding who pays for nursing home care in Massachusetts is crucial. Remember:
- Medicare is for short-term skilled care after a hospital stay (up to 100 days with limits).
- MassHealth is the primary payer for long-term nursing home care (both skilled and custodial) for those who meet the strict financial and medical requirements.
Navigating Medicare vs. MassHealth nursing home care MA requires careful planning, especially when it comes to MassHealth eligibility. Don’t try to figure it out alone.
Contact Brunelle Medicaid today for a consultation. We can provide personalized guidance based on your family’s situation and explain who pays for nursing home care.
Disclaimer: The information in this article is for general informational purposes only and should not be considered legal or financial advice. 1 MassHealth and Medicare rules can change. Asset and income limits are subject to change (figures current as of early 2025). Please consult with a qualified professional, like the experts at Brunelle Medicaid, for advice tailored to your specific circumstances before making any decisions.
