Medi-Cal Planning Overview

There are two main medical insurance programs provided by the federal government in the United States – Medicare and Medicaid. Medicare typically provides health care coverage if you have a work history and are 65 and older, or are on Social Security Disability benefits.  Medicaid is primarily funded by the federal government, but is administered by each individual state. California’s version of Medicaid is called Medi-Cal.

Many individuals believe that Medicare will pay for long-term care in skilled nursing; however, Medicare does not pay indefinitely, and in some instances, it may not pay at all. Specifically, Medicare only pays for a nursing home for about 100 days.  Additionally, Medicare does not pay for ongoing treatment in skilled nursing for conditions such as Alzheimers or Parkinsons. These are considered custodial nursing stays, which are not covered by Medicare.  In those situations, you are required to either pay out-of-pocket, or qualify for Medi-Cal.  Unlike Medicare, Medi-Cal will pay for nursing home long-term care for the rest of an individual’s life, once qualified as long as they maintain financial eligibility and medical need.