Plain version: long-term care is help with everyday living, such as bathing, dressing or eating, that goes on for months or years after an illness, an injury or simply aging. It is mostly not medical treatment, and that is exactly why ordinary health coverage leaves it out.
Why the coverage is needed:
Medicare and most health insurance, including Medigap, do not pay for custodial care (mostly non-medical help with daily tasks). Medicare's skilled nursing facility benefit is for daily skilled care, not ongoing help at home.
Medi-Cal (California's Medicaid program) can pay for long-term care, but only for people who meet its financial rules. Since January 1, 2026, Medi-Cal counts assets for people who are 65 or older, have a disability or live in a nursing home, so a person with substantial savings may not qualify. Private long-term care (LTC) insurance fills that gap.
Standard levels of care, from most to least medical:
Skilled nursing: the patient's primary need is skilled nursing care available on an extended basis.
Intermediate nursing: a recurring need for skilled nursing supervision plus supportive care, without needing skilled nursing to be continuously available.
Custodial or non-skilled care: help with the basic personal tasks of daily living.
Home care and community-based services: care delivered at home or through community programs instead of in a facility.
Places services are generally provided: nursing homes, assisted living facilities, residential care facilities for the elderly (RCFE), the home setting (personal care), hospice care, respite care and adult day care centers.
Adult day care: medical or nonmedical care for less than 24 hours a day at a licensed facility outside the home.
Respite care: short-term care, in an institution, at home or in a community program, that gives the primary caregiver a break.
California benefit rules to know:
A policy that offers home or community-based care must include six benefits: home health care, adult day care, personal care, homemaker services, hospice services and respite care.
A policy that covers nursing facility confinement must also cover residential care facility care at no less than 70% of the nursing facility benefit. (The separate floor for home care under a comprehensive policy is 50%.)
A policy may not cover skilled nursing care only, or provide significantly more coverage for skilled care in a facility than for lower levels of care. Institutional-only and home-care-only policies are allowed if they carry the required label.