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Guide · California

Coverage and payment basics

Who pays for what is often the first question and the hardest one. Here is how the main programs generally work, with the 2026 amounts Medicare publishes. Only the plan or program can say what applies to a specific person.

Last reviewed October 2, 2026. Facts are linked to the official sources listed at the end of the page.

The amounts below are the 2026 figures published by Medicare.gov and the State of California, checked October 2, 2026. They change, usually each year. Medicare Advantage and Medi-Cal managed care plans have their own rules, so always confirm with the plan.

Medicare: skilled nursing facility stays

Medicare Part A can cover a skilled nursing facility stay when all of its conditions are met. Among them: the person has Part A with days left in the benefit period, has a qualifying inpatient hospital stay, and generally enters the facility within 30 days of leaving the hospital.1

  • Under Original Medicare, the qualifying stay is a medically necessary inpatient stay of at least three days in a row. Time under observation or in the emergency room before admission does not count.1 Count the day of admission as an inpatient, but not the day of discharge.2
  • A Medicare Advantage plan might not require the three-day stay.2
  • Part A covers up to 100 skilled nursing days in each benefit period.1 A benefit period ends after 60 days in a row without inpatient hospital care or skilled care in a facility.2

2026 costs under Original Medicare

Days 1–20
$0 per day, after the $1,736 Part A deductible1
Days 21–100
$217 per day1
Day 101 and after
All costs1

The deductible is not paid again if it was already paid for a hospital stay in the same benefit period.1

Medicare: inpatient rehabilitation

The patient's health care provider must certify the need for intensive rehabilitation, continued medical supervision and coordinated care.3 2026 costs under Original Medicare:

Days 1–60
$0 per day, after the $1,736 deductible3
Days 61–90
$434 per day3
Lifetime reserve days
$868 per day, for up to 60 lifetime reserve days3
After day 150
All costs3

Medicare: home health

Medicare home health is for people who need part-time or intermittent skilled services and are homebound. A doctor or other allowed provider must see the person in person, confirm the need, and order the care, and a Medicare-certified home health agency must provide it.4

  • The person pays nothing for covered home health services. For covered medical equipment, they pay 20% of the Medicare-approved amount after the Part B deductible.4
  • Medicare does not pay for 24-hour care at home, meal delivery, or homemaker services such as shopping and cleaning that are not part of the care plan.4

Medicare: hospice

The hospice doctor, and the person's regular doctor if they have one, certify that the person is terminally ill with a life expectancy of six months or less, and the person chooses comfort care instead of care to cure the illness.5

  • The person pays nothing for hospice care from a Medicare-approved hospice, except a copayment of up to $5 for each prescription for pain and symptom management, and possibly 5% of the Medicare-approved amount for inpatient respite care.5
  • Medicare does not cover room and board at home or where the person lives, such as a nursing home. If the hospice team arranges a short-term inpatient or respite stay, Medicare covers that stay.5

What Medicare does not pay for: long-term care

Medicare, and most health insurance including Medicare Supplement (Medigap) policies, does not pay for long-term care: ongoing help with daily activities such as bathing and dressing, whether at home, in assisted living or in a nursing home.6 Other ways to pay include Medicaid, which is Medi-Cal in California, for people who qualify, and private long-term care insurance if a policy covers it,6 as well as veterans benefits for those who qualify (below) and personal funds.

Medi-Cal

  • Nursing home care. Since January 1, 2023, Medi-Cal managed care plans have been responsible for the full long-term care benefit in skilled nursing facilities.7
  • Asset limit. For people 65 or older, people with a disability, people living in a nursing home and some other groups, the limit is $130,000 for one person plus $65,000 for each additional household member through June 30, 2027. Starting July 1, 2027, it becomes $21,000 for one person and $31,000 for two, plus $1,550 for each additional member. When someone moves into a nursing home, Medi-Cal looks at assets given away in the 30 months before.8
  • Assisted Living Waiver. A Medi-Cal program for assisted living services, offered in 15 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. Participants pay their own room and board, slots are limited, and there is a waitlist.9
  • Adult day health care (CBAS). A Medi-Cal managed care benefit; for plan members, the Medi-Cal plan decides eligibility.10
  • Help at home (IHSS). See the Family Caregiver Guide.

Veterans: Aid and Attendance

Aid and Attendance is a monthly payment added to a VA pension for qualified veterans and survivors. One way to qualify is needing another person's help with daily activities such as bathing, feeding and dressing. You can apply online, by mail with VA Form 21-2680 (an examination form a medical examiner helps complete) or in person at a VA regional office; someone in a nursing home also needs VA Form 21-0779.11

Long-term care insurance

Long-term care insurance is designed to pay or reimburse covered long-term care costs.12 What a policy pays for, and when benefits start, depends on its terms; read the policy or call the insurer.

Free, confidential Medicare counseling

HICAP gives free, confidential one-on-one counseling on Medicare and long-term care insurance. Call 1-800-434-0222.13

Sources

Official government pages, each read on October 2, 2026. Links open in a new tab. Prime Care Link is not affiliated with these agencies.

  1. 1.Medicare.gov — Skilled nursing facility care
  2. 2.Medicare.gov — Medicare Coverage of Skilled Nursing Facility Care (CMS Product No. 10153, August 2025)
  3. 3.Medicare.gov — Inpatient rehabilitation care
  4. 4.Medicare.gov — Home health services
  5. 5.Medicare.gov — Hospice care
  6. 6.Medicare.gov — Long-term care
  7. 7.Department of Health Care Services — Skilled Nursing Facility Long-Term Care Carve-In FAQs
  8. 8.Department of Health Care Services — Asset Limit Frequently Asked Questions
  9. 9.Department of Health Care Services — Assisted Living Waiver
  10. 10.Department of Health Care Services — Community-Based Adult Services
  11. 11.U.S. Department of Veterans Affairs — Aid and Attendance benefits and Housebound allowance
  12. 12.California Department of Insurance — Long Term Care Insurance
  13. 13.California Department of Aging — Medicare Counseling (HICAP)

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