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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.

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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.

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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.

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