Dementia Care Coach Corner
Alzheimer’s disease and related dementias are a group of progressive and irreversible brain disorders that affect 100,000 people in San Diego County. Eventually, adults living with dementia require constant supervision due to the changes in their cognitive abilities, a distressing future for caregivers to face without help. It is important to set up a long-term plan to be prepared for the countless hours of care and financial resources needed for someone with this disease. We’ll dive into the difference between Medicare and Medi-Cal (California’s version of Medicaid) and what these two programs offer for long-term care coverage for dementia in San Diego County.
What is the difference between Medicare and Medi-Cal (Medicaid)?
Medicare and Medi-Cal are two federally funded programs designed to provide assistance to older adults and high-need people in paying for medical expenses. To summarize these complex programs:
- Medicare: A federal insurance program available to adults age 65 and over or those under age 65 with a qualifying disability. Benefits do not require annual renewal and there are no income/asset limitations to qualify for this program.
- Medi-Cal (Medicaid): Medi-Cal is California’s version of the federal insurance program Medicaid. This program is offered free to individuals whose income is at or below 138% of the federal poverty line. Currently, there is no asset limitation to qualify for this program. You can still access Medi-Cal benefits if your income is higher than the limit through Medi-Cal’s “share-of-cost” option where individuals pay a predetermined amount each month before Medi-Cal will pay for the remainder.
Program eligibility can be confusing, especially as the programs change. Do not assume you are or are not eligible for either program (even if you were told in the past that you are not eligible). For example, although there is currently no asset limit, starting January 2026 the asset limit will be set to $130,000 for one person. However, your main home and your main vehicle do not count towards your assets. For a more detailed explanation of each program, San Diego County residents can reach out to Alzheimer’s San Diego through our online form or give us a call at 858.492.4400 during business hours and speak with a trained Dementia Care Coach.
Medi-Cal (Medicaid) and Medicare: Do they cover long-term dementia care?
Medi-Cal and Medicare differ when it comes to long-term care coverage. Historically, Medicare did not cover any long-term care services for people with dementia. As of July 2024, Medicare has rolled out a new Guiding and Improved Dementia Experience (GUIDE) Model to support people with dementia and their care partners. To qualify for GUIDE services, the person with memory loss must have a formal dementia diagnosis. Specifically looking at long-term care, Medicare now offers:
- Coverage for up to $2500 worth of respite care per year
As a person’s dementia progresses, they will eventually need 24/7 care. Although this very limited respite service is a step-up from Medicare not offering any long-term care assistance, it is oftentimes not enough support for families on its own.
Unlike Medicare, Medi-Cal has more comprehensive long-term care options. Medi-Cal covers:
- In Home Support Services
- Adult Day Health Care
- Long-term care in a skilled nursing facility
It is important to note that not all facilities and programs accept Medi-Cal. Our team can help you explore programs and services that are available to you through Medi-Cal. Give us a call at 858.492.4400 today and receive personalized and up-to-date information on Medicare and Medi-Cal.
Alzheimer’s San Diego is Here to Help
Alzheimer’s San Diego’s team of compassionate Dementia Care Coaches can help you learn more about Medi-Cal and Medicare and point you toward local San Diego area resources, like the nonprofit San Diegans For Healthcare Coverage to access assistance. If you live out of state but care for someone living in San Diego County, Alzheimer’s San Diego’s team can assist with Medicaid information and resources.
For personalized dementia support, call us at 858.492.4400 to speak with one of our Dementia Care Coaches who are here to help San Diego County residents and/or those caring for someone living in San Diego County (Spanish speakers available). Also check out our free education classes, social activities, caregiver support groups, & more.
Our “Dementia Care Coach Corner” series is where our team weighs in on unique topics and provide insight that can help people impacted by dementia.
By Heidi Emmenegger
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