One of the most common sources of confusion for families navigating home care is understanding what Medicare actually covers — and what it doesn’t.
Medicare: what it covers and what it doesn’t
Medicare covers skilled home health services — but only under specific conditions: the patient must be homebound, a physician must certify that skilled care is medically necessary, services must be provided by a Medicare-certified agency, and the covered services are time-limited skilled nursing and therapy visits.
What Medicare does NOT cover: custodial care — the personal care and homemaker services most families need most. No ongoing bathing assistance, no help with dressing, no companion care.
Medi-Cal: a different story
Unlike Medicare, Medi-Cal can cover non-medical home care through IHSS (authorized personal care hours for eligible recipients, often provided by family members) and CalAIM Community Supports (personal care and homemaker services provided by enrolled agencies like Care partners).
Eligibility is income-based (approximately $1,732/month for a single individual in 2025). California’s 2024 elimination of the asset test makes many more seniors eligible than before.
Dual eligibles: the strongest coverage combination
Seniors who qualify for both Medicare and Medi-Cal have access to the broadest range of covered services. Medicare covers skilled medical care; Medi-Cal covers long-term personal care and support. CalOptima coordinates these benefits in Orange County.
Long-term care insurance
private LTC insurance policies typically cover in-home personal care and often cover a significant portion of costs. If your parent has a policy, reading it carefully is worth doing early.
Don’t assume you know what’s covered until you’ve checked
Many families leave significant benefits on the table because they assumed their parent didn’t qualify.
Schedule a free consultation — we’ll walk through your situation and tell you exactly what’s available.