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Medicare-MassHealth

MassHealth is a state governed public health insurance program for the low to middle income residents of Massachusetts.  Application for MassHealth is at the state's MassHealth office or online. This program was formerly know as Medicaid.

Medicare is a federal governed program, applied for at the local Social Security Office.  Medicare is for people over 65, people who are permanently disabled and cannot work or people of any age who have kidney failure or long term kidney disease.

If you are low-income, it is possible to get MassHealth while you have Medicare.  People who are eligible for both MassHealth and Medicare are called dual eligibles.  For dual eligibles, MassHealth pays all or part of Medicare premiums and deductibles, and medical bills that Medicare does not cover.  Dual eligibles must join a Medicare Drug Plan to get prescription drug coverage.

MassHealth’s  Lookback Period, and Pre-Planning

In 2006, with the signing of the Deficit Reduction Act, the look-back period was changed from 3 to 5 years.  The general rule is that if an application is made to establish MassHealth eligibility, the state has the right to "lookback," and review financial records extending back 5 years. If the applicant's records show that assets were simply given away, the state will refuse to pay for the cost of the nursing home. If the assets are able to be returned, that will "cure" the penalty, and the state will approve nursing home payments.
Transfers made within the 5 year look-back period subject an applicant to a penalty or disqualification of benefits.  Two factors impact the length of the penalty period: (1) the value of the asset transferred; and (2) the penalty divisor set by MassHealth, which is currently $274 per day or $8,220 per month.  For example, transferring $300,000 of property will result in a penalty period of more than 36 months (300,000 ÷ $8,220= 36.496). 
This situation becomes problematic for families not aware of the look-back period change prior to transferring assets and applying for MASSHealth to cover long-term costs.   This may not feel fair when a family is confronted with the unexpected reality, but long-term care costs are expensive.  I say this is an attempt by the government to limit taxpayer funded coverage for people that may be trying the system by shielding assets.  In any case, it’s the law.
Lesson here is this… If you may need MassHealth coverage in the future, you need to plan accordingly.  Let your research begin with a call to the Mass Health office at 1-888-665-9993.
You can also complete an eligibility check to find out if you are likely to qualify for MassHealth by answering questions online about your family, your living situation, and your income. You will see the results of the eligibility check right away, on your computer screen.  This check is completely confidential.  There are no questions that ask for any personal information about you, like name or address, or any other information that would identify you.
An eligibility check is not an official application. However, it will give you a good idea of the kinds of questions you will have to answer when you apply and whether you are likely to be eligible for benefits