Medicare vs. Private Pay for Home Care:
What Colorado Families Need to Know

When a parent or loved one needs help at home, the first question most SW Denver families ask is: "Who pays for this?" The answer is rarely simple. Medicare, private pay, long-term care insurance, Colorado Medicaid waivers, and the PACE program all play different roles — and confusing them can lead to costly surprises. This guide breaks down each option in plain English so you can make the best decision for your family in Littleton, Highlands Ranch, Lakewood, or elsewhere in Jefferson and Arapahoe County.

What Medicare Does Cover for Home Care

Medicare Part A and Part B will pay for skilled, medically necessary home health care — but only under specific conditions. To qualify, your loved one must:

• Be homebound (leaving home requires significant effort)
• Have a doctor certify a need for skilled care
• Receive services from a Medicare-certified home health agency

Covered services include:

• Skilled nursing visits — wound care, injections, medication management
• Physical, occupational, and speech therapy
• Medical social services
• Home health aide visits — only when skilled care is also being provided

What Medicare Does NOT Cover

This is the gap that catches families off guard. Medicare was designed to pay for medical care, not custodial care — the daily assistance most aging seniors actually need.

If your loved one in Lakewood or Highlands Ranch simply needs help getting dressed each morning and someone to check in during the day, Medicare will not pay a penny of that cost. This is where families must explore other options.

Private Pay: What It Means and What It Costs in SW Denver

Private pay simply means paying out-of-pocket — from savings, retirement funds, or family contributions — without relying on insurance or government programs. It is the most common way seniors pay for home care nationally, and SW Denver is no exception.

Rates in Jefferson County communities like Littleton and Lakewood generally track close to the Denver metro average. Highlands Ranch, served primarily through Arapahoe County agencies, may run slightly higher due to demand. Always compare at least two to three licensed agencies and ask about minimum hour requirements before committing.

Long-Term Care Insurance

Long-term care (LTC) insurance is a private policy purchased — ideally years before care is needed — to cover custodial services that Medicare won't pay for. If your loved one had the foresight to purchase a policy, it can be a powerful resource.

What LTC Insurance Typically Covers

• Personal care and companion services at home
• Adult day programs
• Assisted living and memory care facilities
• Skilled nursing facility stays

How It Works

Most policies have an elimination period (usually 30–90 days) before benefits kick in — similar to a deductible measured in time. Once active, the policy pays a set daily or monthly benefit amount, typically $100–$200/day, up to the policy's lifetime maximum. Many policies include an inflation protection rider to keep pace with rising care costs.

If you're unsure whether a parent has an LTC policy, check with their financial advisor, look through insurance files, or contact the Colorado Division of Insurance for guidance.

Colorado Medicaid: The HCBS Waiver for Low-Income Seniors

For seniors in Littleton, Lakewood, or elsewhere in Jefferson and Arapahoe County who have limited income and assets, Colorado's Home and Community Based Services (HCBS) waiver — administered through Health First Colorado — can help pay for in-home care that Medicare won't cover.

To qualify, a senior must:

• Meet Colorado Medicaid financial eligibility (generally income at or below 300% of SSI)
• Require a nursing-facility level of care but choose to remain at home
• Be assessed and approved through their local Single Entry Point (SEP) agency

In Jefferson County, the SEP is Jefferson Center for Mental Health / Foothills Gateway. In Arapahoe County, contact Southeast Mental Health or your county's HCBS coordinator. Waitlists exist, so apply as early as possible.

The PACE Program in Colorado

PACE (Program of All-inclusive Care for the Elderly) is a unique Medicare and Medicaid program designed for frail seniors who qualify for nursing home care but want to stay in the community. PACE provides a comprehensive bundle of services — primary care, specialist visits, therapy, personal care, adult day services, medications, and more — under one coordinated team.

InnovAge, one of Colorado's largest PACE providers, operates centers in the Denver metro area and serves seniors in Jefferson and Arapahoe County, including those in Lakewood and the greater Littleton area. There is no out-of-pocket cost for those who qualify for both Medicare and Medicaid.

PACE is a strong option for medically complex seniors whose families are stretched thin managing multiple providers and appointments. To learn more or check eligibility, visit innovage.org or contact your local Area Agency on Aging (Denver Regional Council of Governments serves both Jefferson and Arapahoe County).