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Massachusetts Medicare assistance program options

Medicaid eligibility under the Massachusetts spend-down program is determined six months at a time; applies to the aged, blind, and disabled, as well as long-term care services

Josh Schultz | October 4, 2020

Reviewed by our health policy panel.

The state where you lives makes a difference in how much you pay as a Medicare beneficiary. This page describes resources available to help eligible Massachusetts residents pay for Medicare premiums and cost-sharing. It also provides an overview of Medicaid programs that help qualifying individuals pay for long-term care, which is not generally covered by Medicare.

Does Massachusetts help with my Medicare premiums?

Medicare beneficiaries who are challenged to pay for coverage may find relief in the form of a Medicare Savings Program (MSP). In Massachusetts, these programs may help pay for some premiums and Medicare Part A and B cost-sharing.

  • Qualified Medicare Beneficiary (QMB): The income limit is $1,402 a month if single and $1,888 a month if married. QMB pays for Part A and B cost sharing, and Part B premiums. If a beneficiary owes Part A premiums, QMB also pays for Part A premiums.
  • Specified Low Income Medicare Beneficiary (SLMB):  The maximum allowed income is $1,615 a month if single and $2,176 a month if married. SLMB pays for Part B premiums.
  • Qualified Individuals (QI): Income is limited to $1,774 a month if single and $2,391 a month if married. QI pays for Part B premiums.

Who's eligible for Medicaid for the aged, blind and disabled in Massachusetts?

Medicare covers many services, but has some gaps and may leave beneficiaries responsible for costly out-of-pocket expenses. Some Medicare beneficiaries may qualify for Medicaid ABD to fill in some of those coverage and cost gaps.

In Massachusetts, Medicaid ABD provides extensive dental coverage, including exams and cleanings twice per year, x-rays, extractions, oral surgery, and dentures.

Medicaid ABD also covers eye exams every two years and pays for eyeglasses.

Medicaid is called MassHealth in Massachusetts.

Income eligibility: The income limit is $1,063 a month if single and $1,437 a month if married.

Asset limits: The asset limit is $2,500 if single and $3,000 if married.

Massachusetts Medicaid spend-down for regular Medicaid for the aged, blind and disabled benefits and LTSS 

Applicants who are over-income for Medicaid ABD benefits can qualify by enrolling in Massachusetts’s Medicaid spend-down program.

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Medicaid calculates the portion of a spend-down enrollee’s monthly income above the program’s income limit, which is known as “excess income.” Enrollees activate their spend-down benefits by submitting medical bills equal to that amount.

Spend-down benefits are usually approved in 6-month increments, with additional coverage requiring the beneficiary to show they had additional medical expenses.

The spend-down in Massachusetts covers Long Term Services and Supports (LTSS).

Income eligibility: The income limit is $552 a month if single and $747 a month if married.

Asset limits: The asset limit is $2,000 if single and $3,000 if married.

Or call 866-445-0071 (TTY 771) to speak to a licensed insurance agent.
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Federal assistance with prescription drug costs in Massachusetts

Medicare beneficiaries who also have Medicaid, an MSP, or Supplemental Security Income (SSI) will receive Extra Help. This program lowers prescription expenses under Medicare Part D. Beneficiaries who don’t receive Extra Help automatically can apply for it themselves. The income limit is $1,615 a month for singles (and $2,175 a month for couples), and the asset limit is $14,610 for individuals (and $29,160 for spouses).

How does Massachusetts regulate long-term services and supports (LTSS)?

As the U.S. population ages, a higher percentage of Medicare beneficiaries need long-term care. Medicare generally doesn’t help pay for long-term care, but Medicaid can fill the gap for many Americans. However, eligibility requirements vary from state to state and across the various programs within a state.

Applicants seeking Medicaid long-term care benefits must undergo a needs assessment.

Medicaid nursing home coverage

Income limits: Massachusetts income limits for nursing home coverage are $1,063 a month if single and $1,437 a month if married (and both spouses need nursing home care).

When only one spouse needs Medicaid, the income limit for single applicants applies – and usually only the applicant’s income is counted.

However, nursing home enrollees are not allowed to keep all of their income up to the income limit. Enrollees must pay nearly all their income each month toward their care, although they can keep a small personal needs allowance (of $72.80 a month) and money to pay for health insurance premiums (such as Medicare Part B and Medigap).

Assets limits: The asset limit is $2,000 if single and $3,000 if married and both spouses are applying. If only one spouse has Medicaid, the other spouse can keep up to $128,640.

Certain assets are never counted, including many household effects, family heirlooms, certain prepaid burial arrangements, and one car.

In Massachusetts, applicants for Medicaid nursing home care can’t have more than $893,000 in home equity.

Home and Community Based Services (HCBS) waivers

Medicaid covers community-based LTSS services for applicants who need care, but can still live safely at home or an assisted living facility. Programs that pay for this care are called Home and Community-Based Services (HCBS) waivers because recipients continue living in the community.

Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).

The income limit for single applicants is used when only one spouse needs HCBS, and usually only the applicant’s income is counted.

Asset limits: The asset limit is $2,000 if single and $3,000 if married (and both spouses are applying).

In Massachusetts, HCBS recipients are not allowed to have more than $893,000 in home equity.

Spousal impoverishment protections in Massachusetts

Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits. When only one spouse is applying, only that individual’s income is counted. With most other Medicaid benefits, the income of both spouses is counted – regardless of who is applying.

If one spouse doesn’t need LTSS, spousal impoverishment rules allow that spouse to keep a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their Medicaid spouse’s income.

In Massachusetts in 2020, these spousal impoverishment rules allow community spouses to keep:

Medicaid home equity limit in Massachusetts

Federal law requires states to limit eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a specific dollar amount. In 2020, states set this home equity level based on a federal minimum of $595,000 and maximum of $893,000.

Massachusetts has chosen to use the highest allowed home equity limit – which means applicants for Medicaid LTSS can’t have more than $893,000 in home equity.

Penalties for transferring assets in Massachusetts

Because long-term care is expensive, individuals may consider reducing the value of their assets by giving gifts or selling them at below market value in order to qualify for Medicaid LTSS. To curb these asset transfers, federal law requires states to have a penalty period for Medicaid nursing home applicants who give away or transfer assets for less than their value. States can choose to also have a penalty period for HCBS. Medicaid will not cover LTSS during this period.

Massachusetts has chosen to have a penalty period that applies to nursing home care and HCBS. This penalty is based transfers or gifts made during a 60-month lookback period prior to receiving LTSS. The penalty period is calculated by dividing the amount of money transferred or given away by the cost of care (this is based on a daily rate of about $367 in Massachusetts).

Estate recovery in Massachusetts

State Medicaid agencies have to try to recover long-term related costs that were paid on behalf of beneficiaries after age 55. States also have the option to pursue recoveries for all other Medicaid benefits. This is called estate recovery.

Massachusetts has chosen to recover the cost of all Medicaid benefits. This means that Medicaid expansion enrollees are subject to estate recovery (Massachusetts grants exemptions in some circumstances).

When Medicaid coverage was administered by an insurer, the state will attempt to recover what it paid that insurer. That means the estate recovery amount could be more (or less) than the actual cost of Medicaid services received.

Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid will attempt to recover what it paid for MSP benefits through that date.

Where can Medicare beneficiaries get help in Massachusetts?

Serving Health Insurance Needs of Everyone (SHINE)

In Massachusetts, Medicare counseling is available by contacting the Serving Health Insurance Needs of Everyone (SHINE) program at 800-243-4636.

SHINE can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHINE counselors may also be able to offer referrals to local agencies for services like home care and long-term care. The SHINE’s website has more information about the services it offers.

Elder Law Attorneys

Elder law attorneys are a resource for individuals who want help planning for Medicaid long-term care benefits. The National Academy of Elder Law Attorneys (NAELA) has a search feature beneficiaries can use to find an elder attorney locally.

Massachusetts Aging and Disability Resource Centers (ADRCs)

Medicare beneficiaries in Massachusetts can also receive counseling and assistance from an Aging and Disability Resource Centers (ADRCs). ADRCs can help with applying for long-term care or other services related to aging or living with a disability.
This is a list of the ADRC regional offices in Massachusetts.

Where can I apply for Medicaid in Massachusetts?

Medicaid is administered by the Executive Office of Health and Human Services (EOHHS) in Massachusetts. You can apply for Medicaid ABD or a Medicare Savings Program using this website or by calling the MassHealth customer service center at (800) 841-2900.

Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, where he represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked with hospital, insurer and technology clients.

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