Retirement is a significant change in one’s life, and it can be a more challenging transition if an individual decides to live in an assisted living facility. Understanding the cost of this transition and what might be covered through insurance benefits is a large part of the process. If you need additional assistance to make a decision about assisted living, contact a Denver assisted living facility today.
Medicare vs. Medicaid vs. Social Security
Before reviewing what costs are covered by Medicare, it is important to understand the differences between government programs. All three programs involve money from the federal government, but each program applies to different types of people, and the money from each program must be used differently.
Medicare is a health insurance program for individuals who are 65 or older. Some individuals with disabilities who are under 65 also qualify for Medicare. It covers things like prescription drugs, doctor visits, and other medical expenses. Many people on Medicare pay monthly premiums and deductibles for their insurance. Medicare can pay for part of a nursing home stay, but it does not cover assisted living because it is considered residential rather than clinical.
Medicaid provides financial assistance for medical procedures for low-income adults. There are different tiers of Medicaid coverage depending on how much income you make. Additional services are also available for individuals with disabilities. Medicaid can pay for certain parts of assisted living, including assistance with basic tasks like grooming and dressing, managing medications, and transportation.
Social Security is not a health insurance program. Many people have Social Security tax taken out of their paycheck while they work to receive benefits when they retire. The specific amount they are eligible to receive depends on how much they paid in taxes and at what age they started receiving benefits.
Some individuals receive Social Security benefits before retirement age due to a disability. Disabled people with a certain amount of work history also qualify for monthly disability payments.
Regardless of whether you receive Social Security benefits due to retirement, a disability, or both, these funds can be put toward any expenses associated with an assisted living facility because they are not insurance benefits and are treated as income.
However, most people receive less money in Social Security benefits than it costs to pay for an assisted living facility in full.
Some individuals who receive Medicaid benefits in Colorado also qualify for an Elderly, Blind, and Disabled Waiver, or an EBD waiver. Others may qualify for a Community Mental Health Supports Waiver, or a CMHS waiver. Individuals who apply for an EBD or CMHS waiver must also be members of Health First Colorado, which is another name for Colorado’s state Medicaid program.
Health First Colorado typically uses income to determine if you qualify for assistance. While it is sometimes possible to qualify if you make more than the listed amounts, the typical income limits are as follows:
- One-Member Families: up to $1,616 for adults, up to $1,725 for children, and up to $2,369 for pregnant women.
- Two-Member Families: up to $2,186 for adults, up to $2,334 for children, and up to $3,205 for pregnant women.
- Three-Member Families: up to $2,755 for adults, up to $2,942 for children, and up to $4,040 for pregnant women.
- Four-Member Families: up to $3,325 for adults, up to $3,550 for children, and up to $4,875 for pregnant women.
To qualify for an EBD waiver, you must require support due to a disability or blindness. To qualify for a CMHS waiver, you must have a mental health condition that prevents you from performing routine tasks. Both of these waivers might cover additional expenses that traditional Medicaid might not cover. An individual can apply for these waivers on Health First Colorado’s website.
Q: How Much Does Medicare Pay for Assisted Living in Colorado?
A: In Colorado, assisted living is considered residential instead of clinical, so Medicare does not cover costs associated with assisted living. It covers other things like prescriptions and doctor appointments. Veterans might qualify for funding that they can use for assisted living, and individuals with long-term care insurance might also receive partial coverage. For more information on assisted living funding, contact a Denver assisted living facility.
Q: Does Social Security Pay for Assisted Living in Colorado?
A: Social Security payments are given to eligible individuals who contributed to Social Security tax while they were still working. The amount an individual receives depends on how much they contributed and when they began collecting funds. Since they’re a part of your income, Social Security funds can be used for anything, including assisted living care; however, the cost of assisted living is usually greater than the average monthly Social Security benefit.
Q: What Is the Average Cost of Assisted Living in Colorado?
A: In Colorado, the average cost of assisted living is $4,630 per month. This figure can change based on which city you are seeking assisted living in. Cities like Colorado Springs and Boulder average costs from $5,142 – $5,349, while Denver’s average costs are closer to $3,620 per month. Assisted living typically costs less than a nursing home, but costs are still subject to significant price increases due to inflation.
Q: What Happens if I Don’t Have Enough Social Security to Pay for a Nursing Home in Colorado?
A: Individuals who are 65 or older and disabled and/or blind might qualify for Medicaid. Medicaid covers some costs associated with assisted living, but not all of them. If a senior has a mental health condition, they might qualify for funding from a Community Mental Health Supports Waiver, or CMHS. There are also additional benefits for veterans and long-term care insurance policyholders.
Assisted Living That Fits Your Needs
Cost is a major factor in choosing which assisted living facility is right for you. It is important to understand your options in order to make smart decisions for you or your loved ones. For more information on assisted living costs, contact Rocky Mountain Assisted Living. We have supportive staff who can help answer your questions and give tours of the facility.