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Does Medicare Cover Memory Care? A Detailed Look

11 minute readLast updated December 1, 2023
Written by Rebecca Schier-Akamelu, assisted living writer
Reviewed by Denise Lettau, J.D., wealth management specialistAttorney Denise Lettau has over 15 years of experience in the wealth management industry.
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If your loved one with dementia has Medicare, you may expect it to pay for some of their memory care expenses. In actuality, Medicare covers some specific, part-time services associated with dementia care, but it doesn’t pay for many of the long-term supports your family may need. Whether your loved one receives memory care within a community or prefers to age in place for as long as possible, it’s important to understand how Medicare works and what memory care costs it does and doesn’t cover.

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What is Medicare?

Medicare is a U.S. government-sponsored health care program for seniors and disabled individuals. A person is eligible for Medicare if they meet the following requirements:[01]

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

Medicare includes several plan options and add-ons. These include Parts A, B, C, D, and Medigap.

Parts A and B are considered Original Medicare, which is the most basic coverage that all who qualify for Medicare can receive. The following table [02] shows the types of care services covered for both.

Medicare Part A

Medicare Part B

Inpatient careHealth care provider visits
Home health careOutpatient care
Skilled nursing facility carePreventive care, e.g., annual screenings and vaccinations
Hospice careMedical equipment
Home health care

What other Medicare plans and services are there?

  • Medicare Advantage plans, also referred to as Part C, are offered through private insurance companies. These plans offer the same coverage as Original Medicare and may include additional coverage for things like vision, hearing, and dental. Oftentimes, Part C also includes prescription drug coverage. Anyone enrolled in a Medicare Advantage plan is automatically ineligible for Medigap.
  • Part D is prescription drug coverage that can be added to Original Medicare. It’s offered through private insurance companies and it helps cover the cost of many prescription drugs, including recommended vaccines that Original Medicare does not cover.
  • Medigap, also known as Medicare Supplement Insurance, helps those who can afford it fill “gaps” in their Original Medicare coverage. It’s offered by private insurance companies to help pay for things like copayments, coinsurance, and deductibles. However, it doesn’t pay for long-term care or private-duty nursing.[03]
  • Medicare Special Needs Plans, also known as SNPs, are for people with a disabling chronic condition (like dementia), people who require institutionalized care, or people who qualify for both Medicare and Medicaid.[04] This plan covers everything that Original Medicare and Part C covers with added services for specialized needs.
  • Chronic care management services are offered under Original Medicare to those with at least two chronic conditions that are expected to last at least one year.[05] To receive such services, dementia patients with chronic conditions will work with their doctor on a care plan and health goals, and then sign an agreement.

Can you afford memory care?

Let our free assessment guide you to the best senior living options, tailored to your budget.

Does Medicare pay for memory care costs?

Medicare doesn’t cover the cost of room and board in a memory care facility, but it may pay for some home health care service for dementia patients. It also covers some associated costs of memory care in a facility or at home, as described in the table below.[02]

Covered

Not covered

Cognitive assessments to confirm a dementia or Alzheimer’s diagnosisThe cost of rent in a memory care community or assisted living community
100 days of skilled nursing care followed by a precipitating event, such as a hospital stayLong-term memory care
Care planning to learn about treatment optionsLong-term assistance with activities of daily living at home or in a memory care or assisted living community
Prescriptions to delay the progression of memory lossAlternative therapies such as acupuncture or herbal medicines
Some custodial care services in certain situations

Medical expenses can increase during the 12 months before an Alzheimer’s diagnosis.[06] So, an early diagnosis can help cover medical costs and reduce hospitalizations. A proper diagnosis can help take advantage of any services that can be billed to Medicare, especially screenings and preventive services.

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Does Medicare cover home health care for dementia?

Medicare covers part-time home health care costs for dementia. This is typically defined as care received less than seven days a week or less than eight hours each day over a span of 21 days.[07]

Medicare does sometimes offer exceptions for specific groups or under special circumstances. For instance, if your loved one is a Native American or an Alaska Native, they may be able to receive home health care for their dementia for up to 35 hours per week.[08]

Keep in mind that this coverage is only available for seniors who fit Medicare’s definition of “homebound.” This means they can’t leave home easily without assistance, or that leaving their home isn’t recommended due to their condition.[07]

In addition to skilled nursing care, Medicare covers medical social services and occupational, physical, and speech therapy. Taking advantage of these services may be helpful if you’re trying to decide where your loved one receives long-term care.

If you’re considering home care for your loved one, keep in mind that homemaking tasks and assistance with activities of daily living aren’t typically covered by Medicare if it’s the only care they need. Medicare may sometimes cover custodial care services, but only in addition to medically necessary home health services (like sterile dressings or physical therapy).

Does Medicare cover nursing home care for dementia?

Medicare doesn’t cover the cost of long-term nursing home care for seniors with dementia. However, Medicare may pay for some skilled nursing home care for up to 100 days under limited circumstances. For example, if a senior with dementia has a qualifying inpatient hospital stay that warrants a limited stay in a skilled nursing facility afterward. Patients must need additional skilled nursing services like intravenous fluids or rehabilitative therapies.[10]

Seniors may turn to Medicaid in some instances to pay for a nursing home level of care. If your loved one qualifies for Medicaid, they would need to live in a Medicaid-approved nursing home to take advantage of this coverage.

Are there other payment options and resources for memory care?

Because Medicare doesn’t pay for long-term memory care, families often find different ways to pay for memory care services. There are many surprisingly helpful ways to fund care, including veterans benefits, life insurance, and more.

If you’re not sure whether Medicaid covers memory care facilities in your state, contact your State Medicaid Agency.

If you’re already seeking a home care agency or memory care facility, contact one of our Senior Living Advisors. These experts can provide local guidance and help you find care that fits your loved one’s needs and budget, all at no cost to your family.

SHARE THE ARTICLE

  1. U.S. Department of Health and Human Services. (2022, December 8).Who’s eligible for Medicare?

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

  3. U.S. Centers for Medicare and Medicaid Services. What’s Medicare supplement insurance (Medigap)? Medicare.gov.

  4. U.S. Centers for Medicare and Medicaid Services. How Medicare special needs plans (SNPs) work. Medicare.gov.

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

  6. 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.

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

  8. U.S. Centers for Medicare and Medicaid Services. (2017, August). Medicare and Medicaid benefits for people with dementia.

  9. U.S. Centers for Medicare and Medicaid Services. Nursing home care. Medicare.gov.

  10. U.S. Centers for Medicare and Medicaid Services. Skilled nursing facility (SNF) care. Medicare.gov.

Meet the Author
Rebecca Schier-Akamelu, assisted living writer

Rebecca Schier-Akamelu is a senior copywriter at A Place for Mom, specializing in topics such as assisted living and payment options. With more than a decade of experience as a content creator, Rebecca brings a person-centered approach to her work and holds a certificate in digital media and marketing from Duke University.

Edited by

Marlena Gates

Reviewed by

Denise Lettau, J.D., wealth management specialist

The information contained on this page 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 not endorse the contents of the third-party sites.

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