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Does Medicare Cover Memory Care? A Detailed Look

By Rebecca Schier-AkameluMarch 28, 2022
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The cost of care for someone with Alzheimer’s or another type of dementia can be expensive. Luckily, Medicare can help offset those costs. But navigating the various forms of Medicare in addition to a understanding a diagnosis could get overwhelming. Discover what exactly Medicare is, its various types, and how to determine if your memory care is covered by Medicare.


In this article:


What is Medicare?

Medicare is a U.S. government-sponsored health care program for seniors as well as disabled individuals. A person is eligible for Medicare if they meet the following:

  • They are under 65 and disabled.
  • They are over 65 and have worked and paid Medicare taxes for at least 10 years.
  • They are diagnosed with end-stage renal disease.

Medicare includes several plan options and add-ons. These include Parts A, B, C, D, and Medigap, with premiums and deductibles relative to income.

Parts A and B are considered Original Medicare — the most basic coverage that all who qualify for Medicare can receive. The following tables show the types of care services covered for both. Note that home health services, which include home care services, are always covered.

Medicare Part A

Medicare Part B

  • Inpatient care
  • Health care provider visits
  • Home health care
  • Outpatient care
  • Skilled nursing facility care
  • Preventive care, e.g., annual screenings and vaccinations
  • Hospice care
  • Medical equipment
  • Home health care

Medicare Advantage (Part C)

Medicare Advantage plans, also known as Medicare Part C, are offered through private insurance companies following rules set by Medicare. They combine Part A and Part B coverage (Original Medicare) and many Part C plans include Part D coverage as well.

Like other types of health insurance, you’ll find different types of Medicare Advantage plans. These include health maintenance organization (HMO), preferred provider organization (PPO), and private fee-for-service (PFFS) plans.

Medicare Advantage plans vary, but you can expect your plan to have rules regarding in-network and out-of-network care. People with Medicare Advantage plans are ineligible for Medigap — a key difference to note when considering your Medicare options.

Medicare Part D

Medicare Part D is offered through private insurance companies and covers prescription drugs, including some recommended shots and vaccines. This option can be added to Original Medicare or received through a Medicare Advantage plan that includes drug coverage.

Medigap

Also known as Medicare Supplemental Insurance, Medigap helps you to “fill gaps” in your Original Medicare plan. You can buy Medigap coverage from a private insurance company. It can help pay for things like your copayments, coinsurance, and deductibles. However, it is important to note that Medigap policies do not cover the costs of long-term care or private-duty nursing.

Medicare Special Needs Plans (SNPs)

You’re eligible for a Medicare SNP as long as you live in the plan’s service area and meet eligibility requirements. SNPs cover everything that Medicare Advantage plans cover, with added services tailored to special groups. SNPs are offered to people who fall within the following groups or subsets of these groups:

  • Chronic Condition SNP (C-SNP). You have a severe or disabling chronic condition. This applies to those diagnosed with dementia, neurologic disorders, and many other medical conditions which affect older individuals.
  • Institutional SNP (I-SNP). You live in an institution. This group applies to someone living in a facility offering nursing care or someone who receives this care at home.
  • Dual Eligible SNP (D-SNP). You qualify for both Medicare and Medicaid.

Chronic care management services

If you are someone with at least two chronic conditions that are expected to last at least one year, you may be eligible for a chronic care management service offered under Original Medicare. You’ll work with your doctor on a care plan and health goals and sign an agreement for the service.

Medicare memory care coverage

Medicare does not cover the cost of living in a memory care facility. However, it does cover some of the associated costs of memory care as described in the table below:

Covered

Not covered

  • Cognitive assessments to confirm a dementia or Alzheimer’s diagnosis
  • The cost of renting a unit in a memory care community or assisted living community
  • 100 days of skilled nursing care followed by a precipitating event, such as a hospital stay

  • Long-term memory care

  • Alternative therapies such as acupuncture or herbal medicines
  • Some custodial care services

Medical expenses can begin to increase during the 12 months before an Alzheimer’s diagnosis, according to the Journal of American Geriatrics Society. So, an early diagnosis can help defray medical costs and reduce hospitalizations. A proper diagnosis can help you to take advantage of any services you can bill to Medicare, especially screenings and preventive services.

Other payment options and resources

Since Medicare does not pay for long-term memory care, you may want to consider researching additional ways to pay for memory care services in your area. Don’t lose hope, as there are many surprisingly helpful ways to fund care, including, veterans benefitslife insurance, and more.

If you’re not sure whether Medicare or Medicaid covers memory care facilities in your state, speak to someone from Medicare.gov, or view your state’s profile on the Medicaid website. If you are already seeking a home care agency or memory care facility, contact a Senior Living Advisor. These experts can provide local guidance and help you find care that fits your needs.

Sources

Alzheimer’s Association. Medicare.

Bynum, J. P. W., Rabins, P. V., Weller, W., Niefeld, M., Anderson, G. F., & Wu, A. W. (2004, February). The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital useJournal of the American Geriatrics Society.

Guerrero, A. (2021, July 6). What benefits does Medicare provide for patients? Medicare Resources.

Lin, P., Zhong, Y., Fillit, H. M., Chen, E., & Neumann, P. J. (2016, June 13). Medicare expenditures of individuals with Alzheimer’s disease and related dementias or mild cognitive impairment before and after diagnosisJournal of the American Geriatrics Society.

U.S. Centers for Medicare and Medicaid Services. Chronic care management services. Medicare.gov.

U.S. Centers for Medicare and Medicaid Services. Cognitive assessment & care plan services. Medicare.gov.

U.S. Centers for Medicare and Medicaid Services. Compare Original Medicare & Medicare Advantage. Medicare.gov.

U.S. Centers for Medicare and Medicaid Services. Home health services. Medicare.gov.

U.S. Centers for Medicare and Medicaid Services. How Medicare Special Needs Plans (SNPs) work. Medicare.gov.

U.S. Centers for Medicare and Medicaid Services. Parts of Medicare. Medicare.gov.

U.S. Centers for Medicare and Medicaid Services. Medicare Advantage plans. Medicare.gov.

U.S. Centers for Medicare and Medicaid Services. What’s Medicare Supplement Insurance (Medigap)? Medicare.gov.

U.S. Department of Health and Human Services. (2014, September 11). Who is eligible for Medicare?

White, L., Fishman, P., Basu, A., Crane, P. K., Larson, E. B., & Coe, N. B. (2019, August). Medicare expenditures attributable to dementiaHealth Services Research.

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader.  Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site.  Links to third-party websites are only for the convenience of the reader; A Place for Mom does recommend or endorse the contents of the third-party sites.

Author
Rebecca Schier-Akamelu

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