MassHealth, Medicaid, and Medicare are all government programs for health care. But how do they differ and what do they cover?
Medicare
Medicare is a federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). Insurance companies and other private companies approved by Medicare offer these plans.
Medicare Part A (hospital insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (medical insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Part D (prescription drug coverage) adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
Medicare Supplement covers gaps in coverage like deductibles, coinsurance, and copayments.
Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. Medicare Advantage (also known as Part C) is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
MassHealth
Medicaid is actually called MassHealth in Massachusetts, so they’re the same program. It’s a joint federal/state assistance program designed to pay for health care for individuals that meet certain income and asset guidelines. To qualify for MassHealth your total resources and income must fall below some fairly stringent eligibility limits. There are also restrictions on how you can transfer assets.
Long-Term Care
The difference between Medicare and MassHealth becomes very important when you or a loved one are in need of long-term care in a nursing facility. If you suffer a sudden illness, after you meet your deductible, Medicare will pay for your care in a hospital or nursing facility for 60 days. You can pay a daily coinsurance for an additional 30 days. There are also “lifetime reserve” days that could come into play.
If your need for care is longer or indefinite, then you will be expected to pay out of pocket for your care. However, if you qualify for MassHealth these costs can be paid.
To help families plan for the potential of an extended stay in a long-term care facility, The Heritage Law Center often designs trusts to ensure that you will qualify for MassHealth so that you won’t be forced to spend all of your assets down on a nursing home once your Medicare benefits run out. This can be essential in avoiding nursing home poverty and providing a legacy for your loved ones.
If you’re interested in learning more about trusts and how they work in regard to MassHealth, call 617.299.6976 or send an email to mkarr@maheritagelawcenter.com for a free, initial consultation.
