IMPORTANT INFORMATION You Need To Know
Medicare can not be counted on to cover all health care expenses. MassHealth will usually pay for what Medicare doesn't cover.
In 2021 Medicare will NOT pay the following:
* $185.50 per day for day 21-100 of a covered skilled nursing facility stay
* Custodial care in a skilled nursing facility
* $1,484.00 for inpatient hospital stay, per benefit period
* $371.00 per day for day 61-90 of a covered inpatient hospital stay, per benefit period
* $742.00 per day for days 91 and beyond of a covered inpatient hospital stay
* The first $203.00 incurred under Medicare part B charges
The average time for approval of a MassHealth application is 2 – 4 months from date of submission. If all time deadlines are met, and eligibility is demonstrated, MassHealth will grant retroactive coverage.
In a skilled nursing facility, under the MassHealth program, the applicant is required to pay a monthly Patient Paid Amount or Applied Income Amount to the nursing facility beginning on the first day that coverage is needed. Failure to do so may result in a gap of retroactive eligibility, and you will be responsible for making other payment arrangements for any non-covered days.
If eligibility is denied and an appeal is needed, it can take from 4 – 6 months from the date of the denial to receive adjudication from the hearing officer.
For Long Term Care applications, the following assets need to be :
All Bank accounts in the applicant or spouse’s name that have been open in the past 5 years (even if they have since been closed), including but not limited to, Checking, Savings, Money Market, Christmas Club, Credit Union, CD, and IRA
All investments, in the applicant or spouse’s name that have been open in the past 5 years (even if they have since been closed), including but not limited to, Investment Accounts, Annuities, Mutual Funds, Stock Certificates, Treasury Bills, and Savings Bonds
All life insurance policies owned by the applicant or spouse
All accounts or investments held in a Revocable Trust.
All real estate, including but not limited to, primary residence, rental property, and vacation property.
All motor vehicles and recreational vehicles, including but not limited to, boat, motor home, camper, and motorcycle
Prepaid funeral arrangements
Additional verification required: monthly income, tax returns, health insurance coverage, gifting, spousal living expenses, trust documents, care-giver agreements and pending third party liability lawsuits.