Medicare Long-Term Care Coverage in California: What You Need to Know

Long‑term care is one of the scariest potential expenses many people face as they age. When you or a loved one needs help with day‑to‑day living (bathing, dressing, meals, etc.), who pays? Unfortunately, Medicare is very limited. In California, knowing what Medicare will and will not cover can save you from heartbreaking surprises.

What Is “Long-Term Care”?

“Long-term care” (LTC) refers to services that help with the “activities of daily living” (ADLs)—such as bathing, dressing, toileting, eating, mobility—that people typically need over time because of chronic illness, disability, or aging. It can take place in:

• Nursing homes

• Assisted living or residential care facilities

• In-home care (aides or personal care)

• Adult day care

Because these services are often not medical in nature, Medicare generally does not consider them a covered benefit.

What Medicare Does Cover (Short-Term, Skilled Care)

While Medicare doesn’t cover most long-term care, it does cover some limited care related to recovery or rehabilitation. Here’s how:

Skilled Nursing Facility (SNF) Care

• After a qualifying hospital stay of at least 3 days in a row, Medicare Part A may cover a stay in a skilled nursing facility for rehabilitation or recovery. (Medicare)

• Medicare covers the first 20 days in full (after meeting hospital deductible). (Medicare)

• Days 21–100 require you to pay coinsurance (daily copay). (Medicare)

• After 100 days, Medicare stops paying for SNF care under that benefit period. (Medicare)

Home Health Care

If your doctor orders it, Medicare may cover limited home health services (nursing, therapy) when you're homebound and need skilled care. This is not the same as personal care services for everyday tasks. (Medicare)

Long-Term Care Hospitals

If you’re transferred from an acute hospital to a long-term care hospital (which handles serious conditions over extended periods), Medicare Part A may still apply under hospital benefit rules. (Medicare)

What Medicare Does Not Cover

This is the hard part: most long-term care is excluded. Here’s what Medicare generally will not pay:

• Assisted living facility costs (room, board, supervision) (Medicare)

• Custodial care (help with ADLs) when that’s the only need (Medicare)

• Long stays in a nursing home that are primarily for personal care rather than rehabilitation (National Council on Aging)

California-Specific Options & Resources

Because Medicare’s LTC coverage is so limited, many Californians rely on other programs or insurance to fill the gap.

Medi‑Cal (California Medicaid) for Long-Term Care

• Medi‑Cal can cover long-term care (nursing home and home-based services) for low-income Californians who meet eligibility criteria. (Medicaid Long Term Care)

• Institutional Medi-Cal covers nursing facility costs (room, board, medical care) for people who can no longer live independently. (Medicaid Long Term Care)

• Community-based Medi-Cal waivers (Home- and Community-Based Services, or HCBS) help people receive care at home instead of moving into a nursing facility. (Medicaid Long Term Care)

Private Long-Term Care Insurance

• These policies can cover types of care Medicare doesn’t—like assisted living, in‑home care, facility stays. (California Department of Insurance)

• In California, LTC insurance must include certain minimum benefits (nursing facility, assisted living, and several home services). (California Department of Insurance)

Tips to Protect Yourself

1. Plan Early
   Don’t wait until care is needed. Explore LTC insurance, evaluate your assets, and consider applying for Medi-Cal if eligible.

2. Understand Your Medicare & Medigap Coverage
   Some Medigap plans can help cover the coinsurance for SNF stays (days 21–100). But they don’t add new coverage for custodial care. (National Council on Aging)

3. Know Your Medi-Cal Options
   If your income and assets are low, Medi‑Cal may “bridge” the gap. Be aware of look‑back periods, eligibility rules, and how your assets may affect coverage. (Nolo)

4. Use Home & Community Services When Possible
   Using HCBS (via Medi-Cal) might help delay or avoid needing full nursing home care, which is more expensive.

Final Word

In short: Medicare in California provides very limited long-term care coverage. It can help with short-term skilled care after hospitalizations, but it will not cover assisted living or long-term custodial care. To protect yourself, it’s wise to explore Medi-Cal, private long-term care insurance, or hybrid planning. If you aren’t sure what’s best for your situation, it’s smart to speak with a Medicare or aging services expert who knows California.