“Who Usually Pays for Long-Term Care? Understanding Medicare, Medi-Cal, Personal Resources, and Long-Term Care Insurance – Share of Cost
- Medicare may pay for skilled care in a nursing home for a very short period but no longer than 100 days and only when the patient meets all the Medicare requirements for daily professional care. While people get personal care services simultaneously, Medicare will not pay unless there is a need for daily skilled services that only a nurse or therapist can provide. Medicare may pay for some personal care services at home, but again, only if you also need skilled care daily that only a licensed person can provide. For more details, see the Medicare benefits book available from your Social Security office or call the Social Security Administration toll-free at 800-772-1213.
- Medi-Cal (called Medicaid outside California) pays for necessary health care that Medicare does not cover, but only if you meet federal and state poverty guidelines. You can get the most current information about Medi-Cal from your local county Department of Social Services, legal services Program, or an elder law attorney.
- Most people commonly use Personal Resources to pay for long-term care expenses. These funds come from personal income and resources. When family members and friends at home provide care, necessary skilled care such as equipment, transportation, and other costs not paid by Medicare are also produced from the patient’s income or savings. People who use up their assets paying for long-term care are “spending down” and may become eligible for Medi-Cal.
- Long-Term Care Insurance is designed to pay or reimburse covered long-term care costs. Understanding the coverage provided and how benefits will be paid/refunded before you purchase a Long-Term Care Policy is critical. Long-term care insurance is available from insurance companies selling in California and may be cost-effective for you if you have sufficient available income to pay the premiums.
- Source CA Dept of Ins