Does Medicare Pay For Assisted Living In California

California Home Care Costs:

In 2020, per Genworths 2019 Cost of Care Survey, the average hourly rate for home care across California is $27.98. As with the cost of assisted living, the average range across the state is large. On the low end, in-home care can be found at $22.98 / hour, and on the high end, in-home care can be as much as $33.00 / hour. The least expensive areas of the state for home care are Chico, Visalia, Bakersfield, and Riverside, where the average cost is closer to $22.88 $24.50 / hour. On par with the statewide average, the areas of San Diego and El Centro have average hourly costs of approximately $28.00. The costliest home care can be found in Napa, San Jose, Santa Rosa, and San Francisco, where the cost is approximately $30.00 $33.00 / hour.

Home health care, which is provided by a health professional, is also available and is essentially the same average hourly cost statewide as is home care at $28.00 / hour. However, in some areas of the state, the cost of home health care does have a higher average hourly cost. In the areas of Santa Maria and Santa Cruz, the average cost is approximately $1.00 more per hour, and in Vallejo, it is $2.50 / hour more on average.

What Is Assisted Living

According to the National Institutes of Health and Eldercare.gov, an assisted living facility is a long-term care option combining housing and daily self-care support services. Typically, assisted living facilities dont offer full-time skilled nursing care, but they might help monitor your health and manage your prescription medications. You may be wondering about Medicare coverage of assisted living situations.

Medicare generally does not cover assisted living. Original Medicare includes Part A and Part B . The other two parts of Medicare, Part C and Part D , also dont cover assisted living costs.

Medicare Advantage gives you a different way to receive your Original Medicare benefits you get them through a private insurance company that contracts with Medicare instead of directly from the government. They provide all your Medicare Part A and Part B benefits except hospice care, which Part A continues to cover. Medicare Advantage plans might include other benefits, such as prescription drug coverage or routine dental care.

People who choose assisted living facilities may need help preparing meals, eating, bathing, dressing, attending to personal hygiene, and/or managing their daily medications.

Ssi/ssp Payments For Assisted Living Or Custodial Care

California’s SSI/SSP program also pays for some non-medical custodial long-term care. SSI is paid for by the federal government, but California pays an extra supplement to its residents called the “state supplementary payment” . The SSP amount is higher for those living in a “non-medical out of home care” situation . Someone who receives SSI/SSP in California and lives in an assisted living facility or RCFE receives $1,194 monthly, and the long-term care facility may charge no more than $1,058, leaving a small personal needs allowance for the recipient . A couple living in the same facility and both receiving SSI/SSP would get $2,388 monthly, and the long-term care facility could charge no more than $2,116, leaving a PNA for the couple of $272.

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Can I Get Financial Assistance For Assisted Living Facilities

You may qualify for help from your state if you need long-term assisted living assistance contact your states Medicaid office or State Health Insurance Assistance Program for information.

If you purchased a long-term care insurance policy, you may also qualify for benefits to cover assisted living facilities check your policy documents for more information.

Will Medicare Pay For Assisted Living Or A Skilled Nursing Facility

No. Medicare only pays for medical care, such as doctors and hospital expenses. So medicare does not cover the cost of assisted living. If you spend at least three days in a hospital and are then transferred to a skilled nursing facility or rehabilitation hospital, Medicare will pay for the first 20 days your are in the SNF, and it will pay part of the cost for up to another 80 days. After 100 days in a skilled SNF, Medicare will no longer pick up any of the cost of care.

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Does Medicare Cover Assisted Living

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Medicare doesnt cover the cost of residing in assisted living communities, which are facilities that offer housing and custodial services such as laundry, cooking, managing medications and other activities of daily living for older adults or those living with a disability and eligible otherwise for Medicare. However, it does cover care received at skilled nursing facilities up to 100 days per benefit period. These facilities are equipped to provide more medical care than assisted living communities, when certain requirements are met.

If you move to an assisted living community, Medicare will still cover your approved prescriptions, surgeries, doctors appointments, screenings and medical equipment, just as it did when you lived at home.

Assisted Living Costs Covered By Medicare

Medicare usually wont cover custodial care, but under certain conditions, it may cover skilled nursing care. This is care usually provided or supervised by a certified nursing professional or doctor. It includes services like physical therapy or changing sterile dressings. In assisted living environments, this care may be covered by Medicare Part A.4

However, you wont usually get skilled nursing care at an assisted living facility. Assisted living normally provides custodial care and supervision, but not the type of medical treatment typically found in a nursing home. But there are a few things in an assisted living facility that Medicare may help cover, such as transportation to doctors appointments or some preventive health services.5

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Does Medicare Cover Nursing Home Care In California

Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so its most valuable for those who are recovering from an injury, illness, or surgery.

Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.

What Does Medicare Cover?

Medicare covers a number of specific services, including:

465-8104

California Health Advocates is a nonprofit offering Medicare advocacy and education for seniors living in the state. It works alongside other state and nationwide organizations to advocate for seniors about Medicare-related issues. It also runs outreach sessions and offers support to seniors who need help understanding their Medicare options.

Medicare Might Pay For Short

Medicare Part A will cover the cost of an initial 100-day stay at a skilled nursing facility under specific conditions:

• The illness or injury must have required a hospital stay of at least three days. Some examples include a stroke, fall, pneumonia, heart attack, or surgery.
• After being discharged, a doctor must order continuing care, meaning 24-hour care at a skilled nursing facility for the condition that caused the hospitalization.
• The patient must have been admitted to a Medicare-certified facility within thirty days of the hospital stay.
• The patient must require skilled care such as physical therapy, speech therapy, or other rehabilitative treatment.
• The hospital stay must have been inpatient and not merely time spent in an emergency room or under observation. Also, the day of discharge does not count toward Medicares 3-day minimum stay requirement.
• Medicare will also pay for any conditions that develop during a stay at a skilled nursing facility. An example of this would be an infection that occurs during rehab from surgery.

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Medicare Benefits For Long

Medicare does not cover long-term services. Also known as custodial care, long-term care includes non-medical services and non-skilled assistance, such as help with dressing, bathing and meals. However, under Part A, Medicare benefits include short-term care in an SNF under certain conditions. If you have been an inpatient in a hospital for at least three days, you may qualify for medically necessary SNF coverage for a related illness or injury. Benefits are covered for up to 100 days.

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What Are Other Care Options Covered By Medicare

Medicare Part A covers skilled nursing care, but only in certain conditions and on a short-term basis. It must be provided less than seven days a week or less than eight hours a day over a period of no more than 21 days, with some exceptions.

Some of the other care options that might be covered by Medicare include:

• Home-based care, such as part-time or intermittent home health aide services. Medicare does not, however, cover daily 24-hour care at home. It also doesnt cover meals delivered to your home or homemaker or custodial services if those are the only services you need.
• Hospice and respite care, which are both covered by Medicare. Hospice provides care and support for people who are terminally ill, and respite care is a short inpatient stay for hospice patients with the goal of providing their caregivers with rest.
• Programs of All-Inclusive Care for the Elderly , which is a Medicare/Medicaid program that helps people meet their health care needs in their own community so they dont have to go to a care facility. It covers prescription drugs, doctor visits, transportation assistance, home care and even nursing home stays when theyre necessary.

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The Cost Of Assisted Living Vs Other Types Of Care

Seniors have several long-term care options available to them, including residential and home care, depending on living preferences, individual needs and budget. The least expensive option is adult day health at $1,842, which covers care during the day time hours only. Homemaker services and a home health aide each cost around $6,101 per month. Both help seniors with daily living tasks such as housekeeping and meals, and a home health aide also provides some medical care, such as physical therapy. Assisted living costs around $5,250. Nursing homes provide the maximum level of care with a semiprivate room running around $9,794 per month and a private room around $12,167.

Nursing Home

How Much Does Assisted Living Cost

Assisted living costs an average of $119 a day, or $3,628 a month, according to the governments Administration on Community Living. Juliano-Villani adds that assisted living facilities can cost $5,000 per month, on the lower side.

Most people pay for assisted living out of pocket, with Medicaid or with private long-term care insurance. Some also finance it with reverse mortgages, life insurance options and annuities.

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Medicaid covers some costs of assisted living for residents who qualify. Recipients must:

• Live in the state in which theyre applying for Medicaid.
• Reside in an assisted living facility thats licensed for Medicaid.
• Meet certain financial need requirements.
• Demonstrate a functional need for assisted living.

Benefits and requirements vary from state to state.

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Top Rated Assisted Living Communities By City

For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers, which are also called Home and Community Based Services Waivers or Waiver Funded Services.

Medicaid Includes Coverage For Assisted Living Costs

Medicaid is a joint federal and state program that may provide some coverage for assisted living. Not everyone qualifies for Medicaid. The types of care covered by Medicaid and income qualifications for the program vary from state to state. Visit for more information on what Medicaid covers in your area.6

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Assisted Living Waiver Programs In California

Assisted Living Waiver

The ALW provides a community-based alternative to nursing home care for those who have extensive care needs but want to live in an assisted living facility. This program is open to all California residents. However, to have services covered, participants must live in an assisted living facility that accepts reimbursement from Medi-Cal. Currently, long-term placement is available in the following counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara and Sonoma. Additionally, the ALW doesnt cover room and board, but costs are controlled for those who qualify for Supplemental Security Income.

To determine eligibility for the ALW, individuals undergo an assessment that evaluates their care needs. This assessment, which individuals schedule through their local Care Coordination Agency, is conducted by a registered nurse. To apply for this program, seniors call their local agency for a pre-assessment over the phone and schedule an appointment for the actual assessment.

How Can I Find An Assisted Living Community That Accepts Medicare Or Medicaid

As we or our parents grow older, the looming question of placing our elderly in an assisted living home inevitably presents itself. While some families choose to take care of their aging parents and relatives, its not always something every family can accomplish. It can be from lack of knowledge on how to take care of the elderly, or from issues of distance as we dont always live next to or even in the same state as our parents and relatives as we ourselves grow older. Finding the right answer to the question of how can I find assisted living near me that accepts Medicaid or Medicare? can take time and prove to be a difficult task. What works for one family may not work for all families. Health issues, financial situations, and emotional attachments are just a few of the factors that should be taken into account before making a final decision.

Assisted living communities offer elderly care for patients that will need long term care or short-term assistance. Many care programs can also assist with memory support, and provide services that are tailored to assisting patients with Alzheimers or dementia. There are twenty-four-hour services, so you can be sure youll be getting the right support.

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Applying For Medicaid In California

To apply for Medi-Cal, seniors should contact their local county Department of Social Services. Its also possible to apply online at Covered California or by calling 300-1506. Apply by mail by downloading and printing the correct forms and mailing the application to Covered California, P.O. Box 989725, West Sacramento, CA 95798-9725.

Before You Apply:

Before applying, its important to check the eligibility requirements to make sure they are met. Individuals who are unsure if they meet requirements should consider Medicaid planning through an external agency, including a local Area Agency on Aging.

Information needed to apply includes:

• Proof of citizenship

Alternative State Payments For Assisted Living Expenses

States offer a broad range of alternative coverage for seniors that are not part of the typical Medicaid program. These payments are provided through alternative programs that allow for the waiver of some federal rules such as income eligibility. Most seniors who apply for these waivers must exhibit care needs equivalent to a senior who lives in a nursing home in order to qualify.

Alternative payment programs also have a limited number of spots available, often significantly fewer than Medicaid. Because the waiting list is quite common and lengthy, many seniors will apply well in advance of their actual needs. Support programs differ from region to region and not all programs may be available to seniors statewide. Make sure to ask your enrollment officer about alternative programs available for their location when researching assisted living communities to join.

There are also other non-traditional assistance programs that are available for specific groups of seniors. For example, veterans or the surviving spouse of a veteran have special programs available to help defray the cost of assisted living. Many religious groups and organizations also offer funding for long-term care or have assisted living facilities for seniors that operate on a not for profit model.

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What Are My Other Long

You may have other long-term care options available to you. Talk to your family, your doctor or other health care provider, a person-centered counselor, or a social worker for help deciding what kind of long-term care you need.

Before you make any decisions about long term care, talk to someone you trust to understand more about other long-term care services and supports like the ones listed below. You might want to talk to:

• Your doctor or other health care provider
• A person-centered counselor
• A social worker

If youre in a hospital, nursing home, or working with a home health agency , you can get support to help you understand your options or help you arrange care. Talk to:

• A discharge planner
• A social worker
• An organization in a “No Wrong Door System,” like an Aging and Disability Resource Center , Area Agency on Aging , or Center for Independent Living

American Indians and Alaska Natives can contact their local Indian health care providers for more information.