What assisted living costs in the Bay Area, what Medicare does and does not pay for, and the other ways California families cover the bill.
In this guide
- What you are paying for
- What Medicare does not cover
- Ways families pay
- Steps to take before you commit
- A note on numbers
- Sources
Assisted living is one of the largest bills a family takes on, and in the San Francisco Bay Area it is higher than almost anywhere else in the country. This guide explains how the pricing works, what public programs do and do not cover, and where to look for help. It is general information, not legal or financial advice.
What you are paying for
In California, assisted living is licensed by the state as a Residential Care Facility for the Elderly (RCFE). Most communities charge a monthly fee made up of two parts:
- A base rate for the room, meals, housekeeping, laundry, activities and 24-hour staff presence.
- Care charges on top of the base rate, based on how much help the resident needs with bathing, dressing, medication, moving around and similar tasks.
Ask for the full price sheet, not only the starting rate. Many families find that the final monthly bill is well above the advertised "from" price once care needs are assessed. Also ask about a one-time community or move-in fee, deposits, and how often and by how much rates rise each year.
What Medicare does not cover
Medicare does not pay for long-term custodial care. Medicare.gov lists this kind of care as not covered, and it names assisted living among the places where non-medical long-term care can be received. Most health insurance, including Medigap, does not cover it either.
This surprises many families. Medicare can still pay for medical services that a resident receives while living in assisted living, such as doctor visits, hospital stays, and limited rehabilitation after a qualifying hospital stay. The monthly rent and daily care charges are a separate matter.
Ways families pay
Personal savings and income. Most residents pay from Social Security, pensions, savings and retirement accounts. Some families sell or rent out a home. If you plan to sell a home, talk to a tax professional first about the effect on taxes and on future benefit eligibility.
Long-term care insurance. If the resident bought a policy years ago, read it closely. Check the daily or monthly benefit, the waiting period before payments start, how the policy decides that someone needs care, and whether assisted living is covered. Call the insurer and ask for the claim steps in writing.
Veterans benefits. Some veterans and surviving spouses may qualify for the Aid and Attendance pension benefit. Eligibility depends on service history, income, assets and medical need. A county veterans service officer can review a case at no charge.
Medi-Cal. Medi-Cal, California's Medicaid program, generally pays for nursing home care for people who qualify, and it has limited options for assisted living. California runs an Assisted Living Waiver that pays for care services (not room and board) in some counties and in a limited number of participating communities. Availability, waiting lists and the counties covered change, so confirm the current details with the Department of Health Care Services or your county Medi-Cal office. Not every assisted living community accepts Medi-Cal, so ask before you tour.
Family contributions. Siblings sometimes split the cost. Put any shared arrangement in writing so expectations are clear.
Steps to take before you commit
- Get a care assessment. A doctor, a geriatric care manager or the community's own nurse can describe how much help is needed now and what may be needed later.
- Compare at least three communities using the same list of questions, and ask each for a written price sheet.
- Ask what happens when money runs low. Some communities will keep a resident for a set period after private funds run out; others will not.
- Check the license. California's Community Care Licensing Division, part of the Department of Social Services, licenses these communities and publishes facility search and complaint information.
- Read the admission agreement before signing, and consider having an elder law attorney look at it.
A note on numbers
Prices vary by city, room type and level of care. Treat any average as a rough guide and use real quotes from the communities you are considering. Eria Cares shows prices only where we have a source for them.
Sources
- Medicare.gov, "Long-term care" (medicare.gov/coverage/long-term-care)
- California Department of Social Services, Community Care Licensing Division (cdss.ca.gov)
- California Department of Health Care Services, Assisted Living Waiver (dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx), for current waiver details
