Medicare vs. Medicaid for Long-Term Care in Colorado
There is a moment I've seen happen more times than I can count.
A family finally finds a place for Mom or Dad.
They've toured communities.
Had difficult conversations.
Made a decision that didn't come easily.
Then someone asks...
Medicare will help pay for this... right?
The room usually gets quiet because the answer is often...
No... not the way most people think.
Quick Answer
Medicare primarily pays for medical care. Medicaid may help pay for long-term care for people who qualify. Understanding the difference can help families make better care and financial decisions.
Why So Many Families Get Confused
Most people think that when you turn 65, healthcare is covered. You’ve spent decades paying into it and you’ve done everything you’re supposed to do. It’s perfectly natural to assume that
Once you need it, it will be there
Unfortunately, that may not be the case. That only adds to the confusion
is that Medicare is health insurance that primarily pays for medical care.
Medicaid is a program that can help pay for long-term care and other healthcare services for people who meet certain financial and medical eligibility requirements.
Many people don't realize they're different until a parent suddenly needs assisted living, memory care, or nursing home care.
That's when families discover that one program was built to treat illness...
...while the other may help pay for ongoing care.
And to make things even more confusing, some people qualify for both Medicare and Medicaid, with each program covering different types of services. That's one more reason families are often surprised when they first begin exploring long-term care
Medicare: What It Covers…and What it Doesn’t
Knowledge is power and you need to be powerful for your mom or dad, especially now when they need it most. You should know more about…
What Medicare Usually Covers, which is typically for medical treatments and preventative care, including…
Doctor visits
Hospital stays
Surgery
Preventive screenings
Limited skilled nursing or rehabilitation after a qualifying hospital stay
Some home health services when medically necessary
Medicare is designed to treat illnesses and injuries.
What Medicare Usually Doesn't Cover involves ongoing custodial care & help with daily things like…
Help bathing or dressing
Medication reminders
Meal preparation
Hands-on daily health needs
Most senior community living costs for Independent, Assisted and, Memory Care
Long-term supervision for dementia when diagnosed
Medicare is not designed as a long-term option.
Medicaid: What It Covers…and What it Doesn’t
If your mom or dad is able to qualify for Medicaid, there still are differences…
What Medicaid Usually Covers is typically for long-term care and ongoing support for people who qualify, including…
Long-term nursing home care,
Personal care services, such as help with bathing and dressing
Some home and community-based services that allow people to remain at home
Certain assisted living services through Colorado Medicaid programs
Medical care for eligible individuals
Medicaid is designed to help pay for ongoing care and support for people who meet financial and medical eligibility requirements
What Medicaid Usually Doesn't Cover is a little more inclusive as the programs generally includes things like…
Care in most Senior Care communities,
Room and board in many communities as not all providers accept Medicaid
Care for people who don't meet the financial and medical eligibility requirements
Services that aren't included in your specific Medicaid program
Luxury amenities or upgraded accommodations
Medicaid is designed to help pay for long-term care for people who qualify, but it doesn't cover every cost or every living situation
What I’ve Learned with Families?
Most families don't wait too long because they don't care. Sometimes, it’s just pure confusion
Unfortunately, many don't discover the difference between Medicare and Medicaid until they're already facing:
A hospital discharge
A dementia diagnosis
A sudden move into assisted living
An unexpected monthly care bill
That's when the pressure begins.
Find out more Paying for Care
Questions that Help Understand This
What About the House?
It always comes back to the same question
Housing and long-term care often become connected with the house. For some, it’s the biggest financial resource, which is why it always raises
questions like…
Should we sell the house?
Can we keep it?
Does owning a home affect Medicaid?
Should we transfer ownership?
Pro Tip: Owning a home does not automatically disqualify someone from Medicaid, but the home's treatment depends on the specific Medicaid program, home equity, and whether a spouse or other qualifying individual continues living there.