First, let’s clear up a common misconception. Medicare isn’t designed to cover the cost of long term care. So if you need to be in a nursing home for an extended period, Medicare isn’t going to cover it. This may surprise you- it surprises most people.
Generally speaking, Medicare will pay for the first 20 days of rehab or skilled nursing following your hospitalization (e.g. following a massive stroke). After that, Medicare will pay for another 80 days but there’s a hefty co-pay (at the moment $138 per day). After that, you’re on your own.
In California, if you require skilled nursing beyond that 100 day period (remember it’s 20 days plus the other 80), you will need another source of payment. Options include paying privately, utilizing an existing long term care policy, VA benefits, or Medi-Cal.
Medi-Cal, California’s version of Medicaid, can help pay for long term care. Medi-Cal offers limited help paying for care in the home and offers full payment for care in a skilled nursing home provided the applicant is eligible.
Medi-Cal is governed by an imposing set of regulations. Working to not only achieve Medi-Cal eligibility, but also to avoid a recovery claim by the State down the road, takes careful planning. Talk to an Elder Law attorney so that you understand the rules for eligibility and estate recovery first, then make an informed decision about how to proceed.
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