Medicare Coverage Comparison: Skilled Nursing vs Home Health vs Long-Term Care
| Type of Care | Skilled Nursing Facility (SNF) | Home Health Care | Long-Term Care (Custodial) |
|---|---|---|---|
| Where Care is Provided | Nursing facility / rehab center | Your home | Home, assisted living, or nursing home |
| Main Purpose | Short-term recovery after hospital stay | Medical care at home (nurse or therapy) | Help with daily living over time |
| Requires Hospital Stay? | Yes (typically 3+ inpatient days) | No (in many cases) | No |
| Type of Care | Skilled (therapy, IV meds, wound care) | Skilled (nurse visits, therapy) | Custodial (bathing, dressing, eating) |
| Medicare Coverage | Days 1–20: 100% Days 21–100: Copay After 100: Not covered |
Usually covered if medically necessary and homebound | Not covered by Medicare |
| Length of Coverage | Up to 100 days per benefit period | Intermittent / part-time visits | Ongoing / long-term |
| Key Limitation | Stops when skilled care is no longer needed | Must meet “homebound” and medical criteria | Must be paid out-of-pocket or insured |
| Common Misunderstanding | People think it covers long-term stays | People think it includes full-time caregivers | People think Medicare will pay — it won’t |
Bottom line: Medicare is designed for short-term medical care, not long-term living assistance.
Not sure which type of care applies to your situation?
✔ Get help understanding Medicare coverage
✔ Review long-term care planning options
✔ Compare Medicare Supplement plans
What is the
CA Assisted Living Waiver?
- Eligibility: Must be full-scope Medi-Cal eligible with zero share of cost, require a nursing facility level of care, and be able to pay for room and board.
- Coverage & Availability: The program is authorized in 15 California counties (including Los Angeles, San Diego, and San Francisco) through February 28, 2029.
- Services Provided: Includes care coordination, personalized care plans, 24-hour care, and routine, scheduled nursing visits.
- Goal: To provide a less restrictive, home-like environment, avoiding unnecessary institutionalization.
- Waitlist/Limitations: It is not an entitlement program, and spots are limited, often leading to waitlists. [1, 2, 3, 4, 5]
Participants in the ALW have access to the following services:
- Assisted Living Services: The following is a list of some of the services that must be provided to ALW participants. These services may be provided in an RCFE, or by a licensed Home Health Agency to residents in public housing.
- Assisting in developing and updating an individualized care plan for each resident
- Personal care and assistance with activities of daily living
- Laundry
- Housekeeping
- Maintenance of the facility
- Providing intermittent skilled nursing care
- Meals and snacks
- Providing assistance with self-administration of medications
- Providing or coordinating transportation
- Providing recreational activities
- Providing social services
- Care Coordination: These services include identifying, organizing, coordinating and monitoring services needed by participants .
- Nursing Facility Transition Care Coordination: These services help transition participants from a nursing home to the community. CA Assisted Living Waiver
Resources & Links
- DHCS.CA.Gov – CA Department of Health Care Services
- Assisted Living Waiver
- Elder Options – Private Website – DHCS subcontractor that can help people in Sacramento Area
- Nolo Press
FAQs / Ask Us a Question
Question
My 92 year old mother is on Medi-cal and Scan, but needs to go into assisted living with waiver application. They won’t accept Scan. They said she has to drop it. Does she automatically go on Medi–Medi and will her new doctor take it? The application takes 3-6 months for approval but I have to drop her from Scan insurance before I fax over the waiver form…
Answer
***I don’t have enough background to answer your question. I did learn though, my first day at my Father’s & Grand Fathers Insurance Agency, to NEVER cancel coverage till new coverage was confirmed!
Learn more chcf.org what-is-assisted-living/
