Long-term care insurance: what Massachusetts requires
If you already have a long-term care policy, find it and read it before care starts. Massachusetts sets minimum standards for policies. A policy that meets MassHealth's minimum can also protect your home from being counted, and from estate recovery, if you later need MassHealth in a nursing home.
The numbers
| Minimum lifetime benefit (MA individual policies) | 730 days after the elimination period |
| Longest allowed elimination (waiting) period | 365 days |
| Pre-existing condition exclusion, at most | 6 months from the policy start |
| MassHealth home-protection minimum daily benefit | $125 a day in a nursing facility |
Massachusetts minimum standards
Individual policies sold in Massachusetts must be guaranteed renewable or noncancelable, cover at least 730 days of benefits after the waiting period, and cannot have a waiting period longer than 365 days. They cannot exclude people because of Alzheimer's disease or mental or nervous conditions.
The MassHealth connection
If you enter a nursing home owning a policy issued on or after March 15, 1999 that covers at least $125 a day for at least 730 days in a nursing facility, MassHealth does not treat your former home as a countable asset. MassHealth also does not seek repayment from the home in certain cases for people who held such a policy.
Using a policy
Call the insurer early to learn the claim process, what counts as a covered care setting, and when the waiting period starts.
Mistakes families make
- Letting a policy lapse during illness or memory loss. Name a backup person to receive lapse notices.
- Not starting the waiting period as soon as care begins.
Who to call on Cape Cod
| Who | Number | For |
|---|---|---|
| Massachusetts Division of Insurance — Consumer Services | (877) 563-4467 | Questions or complaints about a policy |
| SHINE — Cape & Islands | (508) 375-6762 | Free, unbiased help with Medicare, MassHealth and plan choices |
What we could not confirm: Kept short on purpose: premiums, carriers and tax rules were not verified. The Division of Insurance phone number comes from its 2023 policy list. The 'backup person for lapse notices' tip is common practice and is protected by 211 CMR 65.10 (protection against unintentional lapse); ask your insurer how to name someone.
Next: All the ways to pay for care · Two-minute benefits check · What care costs on the Cape · Elder law attorneys
This page explains the rules; it is not legal advice. For your own situation, talk to an elder law attorney or SHINE.