Individuals who have a long-term care insurance policy that meets certain coverage requirements may be exempt from some MassHealth (Medicaid) eligibility and recovery rules. These rules determine:
• Whether an individual's home will have to be sold in order to become eligible for MassHealth benefits; and
• Whether the individual or his or her estate may have to repay MassHealth for any of the long-term care expenses MassHealth paid for the individual.
Qualifying long-term care insurance policies. A long-term care policy must provide certain benefits for an individual to qualify for the MassHealth eligibility and recovery exemptions. More specifically, when an individual enters a nursing home, the policy must:
• Cover nursing home care for at least 730 days;
• Pay at least $125 per day for nursing home care; and
• Not require an elimination period of more than 365 days or, in lieu of a waiting period, a deductible of more than $54,750.
Additionally, a policy must meet certain minimum standards set by the Massachusetts Division of Insurance in order to qualify for MassHealth exemptions (see 211 CMR 65.05
). For more information on long-term care MassHealth exemptions, visit Massachusetts’ Executive Office of Elder Affairs at http://www.mass.gov/elders/healthcare/masshealth/ltc-exemptions