Medicare & Long-Term Care: What’s Covered and What’s Not?

For seniors in Monument and northern El Paso County, Colorado, understanding what Medicare does—and doesn’t—cover when it comes to long-term care is essential. From nursing homes to assisted living and home health services, the coverage landscape can be tricky. Knowing your options helps prevent unexpected costs and allows for more confident care planning.For seniors in Monument and northern El Paso County, Colorado, understanding what Medicare does—and doesn’t—cover when it comes to long-term care is essential. From nursing homes to assisted living and home health services, the coverage landscape can be tricky. Knowing your options helps prevent unexpected costs and allows for more confident care planning.

What Medicare Covers – and What It Doesn’t

Medicare is a federal health insurance program for people 65 and older, and for younger individuals with certain disabilities or conditions. It’s divided into several parts:

  • Part A: Covers inpatient care, skilled nursing facilities, hospice, and limited home health services.
  • Part B: Covers outpatient care, preventive services, and medically necessary treatments.

Long-term care, on the other hand, includes ongoing help with daily tasks like bathing, eating, or dressing—what’s called custodial care. Medicare generally does not cover this kind of non-medical assistance.

How Does Medicare Relate to Long-Term Care?

Original Medicare covers skilled medical care but generally does not cover long-term custodial care. Eligibility for Original Medicare requires being 65 or older (or meeting other specific criteria), with sufficient work history contributing to Medicare taxes or qualifying via disability status.

1. Nursing Home Care and Medicare

Medicare does cover short-term skilled nursing facility (SNF) care, but only under specific conditions:

  • You must be hospitalized for at least three consecutive days before SNF admission.
  • The care must be related to your hospital stay and deemed medically necessary.

Coverage limits:

  • Days 1–20: Fully covered by Medicare.
  • Days 21–100: You pay a daily coinsurance.
  • After day 100: You’re responsible for all costs.

Medicare does not cover extended custodial stays, which means if you need help with daily tasks long-term, other financial options will be needed.

2. Assisted Living: Limited Medicare Coverage

Assisted living communities offer housing plus support with daily activities, but they’re not medical facilities. So:

  • Medicare doesn’t cover room, board, or personal care services in assisted living.
  • What is covered? Medically necessary care within those settings—like a visiting nurse, therapy, or doctor’s visit—can be covered by Parts A or B.
  • Medicare Advantage plans may offer extra benefits like transportation or wellness support, but they still won’t pay for housing or meals.

3. Home Healthcare Through Medicare

Medicare does offer broader support for home health services, as long as they meet medical necessity criteria and are ordered by your doctor.

Covered services include:

  • Skilled nursing care (part-time)
  • Physical, speech, and occupational therapy
  • Medical social services
  • Some home health aide support (if skilled care is also required)

Custodial care at home, however, like help with cooking or cleaning, is not covered unless it’s part of a skilled care plan.

Planning Ahead: Alternative Long-Term Care Funding

Because Medicare doesn’t fully cover long-term care, it’s wise to consider other options:

  • Medicaid: Offers long-term care support for low-income individuals. Colorado has programs and waivers to help seniors remain in their homes or assisted living.
  • Veterans Benefits: Eligible veterans may qualify for Aid & Attendance or VA-provided home health support.
  • Long-Term Care Insurance: Can cover custodial care services not included in Medicare. It’s best to purchase while you’re still healthy and eligible.

Local Support: Elizabeth Bryson Insurance Group

At Elizabeth Bryson Insurance Group, I specialize in helping seniors understand Medicare and navigate their long-term care options. I’m proud to serve the Monument and northern El Paso County community with:

  • Free consultations
  • Enrollment assistance
  • Education on Medicare and long-term care planning

Whether you’re just turning 65 or helping a loved one prepare, I’ll help you build a coverage strategy that fits your needs and budget.

Contact Information

To schedule an appointment or inquire about services, you can reach out using the following contact details:

I offer flexible appointment options including office visits, phone calls, and Zoom meetings to accommodate your preferences.

Whether you’re seeking guidance on your Medicare choices or have questions about long-term care coverage, don’t hesitate to reach out to the Elizabeth Bryson Insurance Group for assistance.

The Importance of the Initial Enrollment Period (IEP)

The Initial Enrollment Period (IEP) is a seven-month window that includes three months before your 65th birthday, your birthday month, and three months after. During this time, you have the opportunity to enroll in Medicare for the first time. It’s essential to make informed decisions during this period as it sets the foundation for your healthcare coverage in the years to come.

Don’t Wait—Plan Early

Timing is everything. Your Initial Enrollment Period (IEP)—the 7-month window around your 65th birthday—is the best time to get started with Medicare. Missing it could mean late penalties or missed opportunities to add supplemental coverage like Medigap or Medicare Advantage.

Choosing the right plan can protect your finances, ensure access to your doctors, and bring peace of mind. The more you understand now, the smoother your future healthcare journey will be.

Bottom Line

Medicare provides excellent coverage for medical care but leaves significant gaps when it comes to long-term support like assisted living or extended nursing home stays. That’s why planning ahead—exploring Medicaid, long-term care insurance, or veteran benefits—is key to securing a comfortable future.

You’re not alone in this process. I am here to help you every step of the way.

Remember, early preparation is key! Don’t wait until the last minute to understand your Medicare options. Start reviewing and comparing plans now so that you can make informed decisions during your IEP.