- Eastbay Healthcare Services
- Residential Care Facility
- 925 477 7320
We understand that quality care is an important investment, and for many families, the cost of long-term care can feel overwhelming. While we gladly welcome private-pay residents, we also actively work with various insurance and assistance programs that may help cover part or all of the cost of care.
Over the years, we have successfully supported residents whose care is funded through different insurance and assistance options. Our goal is to make compassionate care more accessible while guiding families through available payment pathways.
Below is an overview of the most common insurance and assistance programs we work with. If you have specific questions or would like help understanding eligibility, we encourage you to contact us directly.
What It Is
Long-Term Care Insurance is designed to cover expenses associated with long-term care services. Because residential care facilities provide long-term assistance with daily living, LTC insurance can often be used to cover part or all of the monthly care costs when policy requirements are met.
How Residents Qualify
LTC insurance is commonly obtained through:
Life insurance policies with LTC riders
Retirement or employment benefit plans
Privately purchased policies
Coverage details vary widely depending on the policy.
Coverage & Rates
Each policy includes specific limits and caps, which may include:
Daily payment limits
Monthly payment limits
Annual payment limits
Lifetime maximum benefits
Possible cost-of-living increases
Understanding these limits is essential, as they determine how much of the care cost the policy will cover.
How Payments Are Made
Payments may be made:
Directly to the care facility, or
As reimbursement to the resident or beneficiary
Additional Covered Benefits
Some LTC policies may also cover:
Durable Medical Equipment (wheelchairs, walkers, hospital beds, etc.)
Incontinence supplies
Requirements
Both the resident and the care facility must meet the policy’s care, licensing, and documentation requirements for coverage to remain active.
What It Is
Medi-Cal is California’s public health insurance program for individuals with limited income. Certain Medi-Cal programs can help cover the cost of care in a residential care facility.
Important Note on Eligibility
Approval for Medi-Cal does not automatically guarantee approval for programs that cover residential care costs, such as Assisted Living Waiver (ALW) programs. Separate approvals are often required.
How Residents Qualify
Eligibility is based on income
Additional applications may be required for specific Medi-Cal programs
Payments & Rates
Medi-Cal programs operate on contracted rates that may be based on:
Level of care
Medical diagnosis
Daily or hourly service rates
Payments are typically made directly to the care facility.
Additional Benefits
Medi-Cal often covers:
Durable Medical Equipment
Incontinence supplies
Prescription and over-the-counter medications
Hospice services
Ongoing Requirements
Active Medi-Cal coverage must be maintained
Facilities are subject to regular inspections
Residents may receive routine wellness visits from care coordinators
What It Is
Medicare is a federal insurance program for individuals aged 65 and older, or those with qualifying disabilities.
Residential Care Coverage
Original Medicare does not cover the cost of residential care rent. However, it does provide valuable medical benefits that support residents.
Covered Services Include
Home health services (nursing, therapy services)
Hospice care
Physician visits and diagnostic services
Durable Medical Equipment
Prescription medications under Medicare Part D
These services often complement residential care services.
What It Is
VA Aid & Attendance is an additional benefit available to qualifying veterans and surviving spouses who require assistance with daily living activities.
How It Helps
Because residential care facilities provide daily assistance, this benefit can help offset monthly care costs.
Eligibility
Available to qualifying veterans and surviving spouses
Determined through an application and medical need assessment
Payments
Payments are made directly to the qualified individual
Funds can be applied toward residential care costs
Additional Benefits
May include coverage for incontinence supplies
Facility Requirements
As long as the facility is properly licensed and meets care standards, the benefit typically remains active.
What They Are
HMO plans are managed care insurance plans with defined provider networks. In certain cases, HMO plans may help cover residential care costs based on medical necessity.
Eligibility Factors
Coverage decisions are typically based on:
Medical diagnosis
Level of care required
Rates & Payments
Rates are negotiated on a case-by-case basis
Payments are typically made directly to the care facility
Additional Negotiated Benefits May Include
Durable Medical Equipment
Incontinence supplies
Home health services
Hospice care
Contracts & Requirements
Each HMO has specific care and documentation requirements. Coverage depends on both the resident and the facility meeting these standards.
We know insurance and care funding can feel complex. Our team is here to:
Review your available options
Help you understand potential coverage
Answer questions about eligibility and next steps
📞 Contact us today to speak with our team and learn more about how we can support you or your loved one.
