Understanding Medi-Cal

How You Will Pay for Long-Term Care Services

Wait… Doesn’t Medicare or Private Health Insurance Pay for Everything? According to GenWorth, the average cost of long-term care in California is $10,000 per month for a nursing home room(semiprivate) and $6,500 per month for assisted living on average. puts the cost of home health aides between $25-$30 per hour—and that’s not counting additional medical equipment and services which often cost families more than $30,000 per year! The big elephant in the room when a family faces such excessive costs is usually the questions of, “Who in the world is going to pay for this care?” “Is Medicare or health insurance going to pick up the tab?”

Unfortunately, the answer is no.

Many people are confused about the difference between Medicare and Medi-Cal as it pertains to the challenge of paying for expensive long-term care. This is not surprising. The two programs sound similar and both provide for medical care. However, Medicare by and large, does not cover long-term nursing home care. For example, Medicare Part A will only cover up to 100 days in a skilled nursing facility for a particular illness, and only after the patient has spent at least three days in a hospital. 3

Worse, from day 21 to day 100, the individual in the skilled nursing facility must make a copayment of $167.50 per day. Few people actually receive Medicare coverage for the full 100 days, in part because of the copay, and in part because restrictions and conditions for coverage are quite stringent.

Medi-Cal, on the other, does cover long-term nursing home care for people who meet certain asset limits. One hundred days, one year, five years—Medi-Cal will pay for the care as long as the recipient is eligible. Given the high cost of nursing home care, the dearth of affordable alternatives, and the restrictions inherent in Medicare coverage, Medi-Cal is now the single largest payer of nursing home stays in the United States.

The bottom line is this: While Medicare can help pay for a short-term stay in a nursing home, Medi- Cal can pay for long-term care. Through proper planning, you can obtain assistance from Medi-Cal to pay for nursing home care, and protect your hard-earned assets in the process. The sooner you start planning, the better your chances of getting the care you need while protecting most, if not all, of your assets.

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