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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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]
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 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 |
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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 diagnosis | The 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 stay | Long-term memory care |
| Care planning to learn about treatment options | Long-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 loss | Alternative 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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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).
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.
Read more:VA Memory Care Resources for Veterans
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.
U.S. Department of Health and Human Services. (2022, December 8).Who’s eligible for Medicare?
U.S. Centers for Medicare and Medicaid Services. Parts of Medicare. Medicare.gov.
U.S. Centers for Medicare and Medicaid Services. What’s Medicare supplement insurance (Medigap)? 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. Chronic care management services. Medicare.gov.
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. Home health services. Medicare.gov.
U.S. Centers for Medicare and Medicaid Services. (2017, August). Medicare and Medicaid benefits for people with dementia.
U.S. Centers for Medicare and Medicaid Services. Nursing home care. Medicare.gov.
U.S. Centers for Medicare and Medicaid Services. Skilled nursing facility (SNF) care. Medicare.gov.
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