What care costs in Massachusetts
These are median prices from the 2025 Cost of Care Survey by CareScout, a Genworth company. It reached out to providers between July and November 2025 and published the data in March 2026. A median means half of the providers charge more.
| Type of care | Massachusetts | U.S. national |
|---|---|---|
| Assisted living community | $9,600 a month ($115,200 a year) | $6,200 a month ($74,400 a year) |
| Nursing home, semi-private room | $14,448 a month ($173,375 a year, $475 a day) | $315 a day ($114,975 a year) |
| Nursing home, private room | $15,817 a month ($189,800 a year, $520 a day) | $355 a day ($129,575 a year) |
| Non-medical caregiver at home | $40 an hour ($91,520 a year at 44 hours a week) | $35 an hour |
| Adult day health care | $112 a day ($29,120 a year at 5 days a week) | $24,700 a year |
Prices differ a lot from one building to the next, and many assisted living communities charge extra as care needs grow. Ask each place for its full fee schedule in writing.
MassHealth publishes its own figure for what a nursing facility costs: an average of $450 a day in its 2026 table. It uses a figure like this when it calculates penalties for transfers (see the look-back section below).
Ways families pay for care
- Savings, income and Social Security. The first source for most people.
- Medicare. The state’s own page says Medicare covers a limited stay in a nursing home for skilled care, after a 3-day hospital stay, with day limits. It is not built for long stays.
- Long-term care insurance. Read the policy for the benefit amount, waiting period and what counts as care.
- Veterans’ benefits. Ask your town’s veterans’ agent or the VA.
- Home equity. Selling, renting out the house, or a reverse mortgage. See below.
- MassHealth. The state-federal program that pays for nursing home care when assets and income are low. It has strict rules about the house and gifts.
Mass.gov’s page on paying for a nursing or rest home covers each of these. It also points to the SHINE program for health insurance questions. SHINE is free counseling on Medicare and health insurance choices. It is not legal advice and it does not plan Medicaid eligibility.
Using the equity in the house
| Option | How it works | Things to weigh |
|---|---|---|
| Sell the house | Net proceeds go toward care. Compare listing with other routes in the cash offer vs listing tool and estimate cash in the net proceeds calculator. | Proceeds count as assets for MassHealth. A married person’s spouse may still need a place to live. Selling for less than market value to a relative counts as a transfer. |
| Keep and rent it out | Rent helps pay for care. The sell or rent calculator can help compare. | Landlord work, repairs, insurance, income tax on rent. Ask the attorney how rent is treated for MassHealth. |
| Reverse mortgage | Only works while a borrower lives in the home. See reverse mortgage and selling. | Usually not a fit if the person is moving out for good. |
| Home equity loan or line | Borrow against the house. | Needs income to repay. See home equity loan payoff at sale. |
On taxes: the federal home sale exclusion is $250,000, or $500,000 for a married couple filing jointly. If you can no longer care for yourself and used the home as your main home for at least 12 of the 5 years before the sale, time in a licensed care facility counts toward the 2-year residence test (IRS Pub. 523). See also the downsizing guide.
If a parent cannot sign, the person who sells needs legal authority, such as a valid power of attorney or a court appointment. Get an attorney’s help on the right paperwork before listing.
MassHealth basics for nursing home care
MassHealth is Massachusetts’ Medicaid program. The numbers below are the official 2026 figures from Mass.gov and the regulation 130 CMR 520.000. Rules change and have many exceptions.
| Rule | What the official sources say |
|---|---|
| Asset limit | About $2,000 in countable assets for one person (MassHealth 2026 table; Mass.gov “Paying for a stay in a nursing or rest home”). |
| The home | A home in Massachusetts used as the principal residence is a noncountable asset, except when the equity is above the limit. If the person moves out without intent to return, it becomes countable. |
| Home equity limit | $1,130,000 for 2026 (Mass.gov). The limit does not apply when a spouse, a child under 21, or a blind or permanently and totally disabled child lives in the home (130 CMR 520.007). |
| Money from selling the home | It counts as an asset. The regulation exempts sale proceeds only when they are used to buy another home that will be the principal residence. |
| Spouse at home (community spouse) | The spouse may keep a share of assets: in 2026, between $32,532 (minimum) and $162,660 (maximum), plus an income allowance. Details are set by MassHealth. |
| A lien on the home | MassHealth may place a lien on real estate while the member is alive (130 CMR 515.012). Ask an attorney how that affects a sale. |
This is the state’s general rule, not a prediction for your family. MassHealth also has income rules, a Patient Paid Amount and a personal needs allowance ($72.80 a month in the Mass.gov table). An elder law attorney can check the numbers for your case.
The 5-year look-back
When someone applies for MassHealth nursing facility coverage, MassHealth looks back at transfers made in the prior 60 months (5 years). If assets were given away or sold for less than fair market value, MassHealth can deny payment for nursing facility services for a period of time.
The regulation sets the length of that period: the total uncompensated value of the transfers divided by the average monthly cost of a private-pay nursing facility stay in Massachusetts at the time of application, as set by MassHealth. The rules list exceptions and are detailed, so ask an attorney which apply.
- Do not give money, the house or other assets to family before you speak with an elder law attorney.
- Keep records of large withdrawals and gifts. MassHealth asks for them.
- Selling the house to a relative below market value counts as a transfer.
Estate recovery
After a MassHealth member dies, the state can seek repayment from the member’s probate estate. A law signed in September 2024 limited MassHealth estate recovery to what federal law requires, for deaths on or after August 1, 2024. According to MassHealth’s FAQ:
- It applies to people who got MassHealth for nursing facility services, home and community-based services, and related hospital and drug services at age 55 or older, and to people of any age who were in a nursing home or similar institution.
- It reaches only the probate estate. Assets that pass outside probate, such as most IRAs, 401(k)s and life insurance with a beneficiary, are generally not subject to recovery, with exceptions.
- MassHealth waives recovery for probate estates of $25,000 or less.
- Recovery can be put off (deferred) while a surviving spouse, a child under 21, or a blind or disabled child is alive.
- There are hardship waivers, for example for an heir who lived in the home and provided care.
Estate recovery is where many families first learn that a house mattered. See the executor checklist if you are on the other side of this, handling an estate.
Who to talk to before you sell
- An elder law attorney. This is the first call. Find one through the Massachusetts Bar Association Lawyer Referral Service or the NAELA lawyer directory. Ask about the first-meeting fee.
- MassOptions, 1-800-243-4636. Free help finding services and options counseling from the state.
- SHINE (same phone number, 1-800-243-4636). Free counseling on Medicare and health insurance. Ask for your local SHINE office.
- MassHealth Enrollment Center, 1-800-841-2900, to apply.
- A CPA for income tax on the sale.
Please do not use this page to plan a transfer. The rules are strict and the cost of a mistake can be months without coverage.