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:
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:
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
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 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.
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.
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:
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 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:
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.
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 benefits, life 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.
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 use. Journal 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 diagnosis. Journal 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 dementia. Health Services Research.
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