LONG TERM CARE 3
California Department of Insurance
Protecting California Consumers
Toll Free 800-927-HELP
Health Factors
Certain health conditions, like Alzheimer’s or a stroke,
can cause a need for long-
term care. If you know that certain health conditions run
in your family, you may have a greater risk of needing long-term
care than another person of the same age and gender. Unfortunately,
it may be that this known health condition could also make
you ineligible to buy this type of insurance.
How Much Does Long-Term Care Cost?
In 2002, the cost of nursing home care in California averages
$141 a day. Costs may be lower in rural areas and higher in
suburban and urban areas. A short 30-day stay could cost $4,230
or more; a 3 month stay, $12,690 or more; and, a year stay,
$50,000 or more. The cost of care in the future will be much
higher than it is today. California nursing home rates increased
at an average rate of over 5% per year during the past twenty
years¹ and are likely in the future to continue to increase
by at least 5% per year. A 5% annual increase means a year
of care that costs $50,000 today will cost twice that amount
in 14 years, or $100,000 a year!
Issuers Bulletin for 2002, California Partnership for Long-Term
Care, based on data from the California Office of Statewide
Health Planning and Development.
Who Usually Pays For Long-Term Care?
Medicare may pay for skilled care in a nursing home for a
very short period of time - but no longer than 100 days -
and only when the patient meets all the Medicare requirements
for daily skilled care.
While people do get personal care services at the same time,
Medicare will not pay unless there is also 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 on a daily basis
that only a licensed person can provide. For more details,
see the Medicare benefits book available from your Social
Security office or by calling the Social Security Administration,
toll-free at
800-772-1213.
Medi-Cal (called Medicaid
outside California) pays for necessary health care that is
not covered by Medicare, but only if you meet federal and
state poverty guidelines. In 2002, a single person over 65
would qualify for Medi-Cal if he/she had $2,000 or less in
non-housing assets. A married spouse, living in the community,
however, can keep up to $89,280 in non-housing assets and
$2,232 in joint monthly income, when his or her spouse is
in a nursing home and applies for Medi-Cal. These guidelines
and the amount of assets and income a person may keep can
change annually.
Note: Non-housing assets are mentioned several times
in this guide. In general, the value of a person’s house is
not counted when applying for Medi-Cal. While the state does
have estate recovery rights after the death of a Medi-Cal
beneficiary, there are certain exemptions that apply, particularly
for surviving spouses. There are certain rules that the state
must follow if it is to be successful in recovering any amounts
the program paid. 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.
California Department of Insurance
Protecting California Consumers
Toll Free 800-927-HELP
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