If your loved one has Medicare, you may expect that it will pay for some of their memory care expenses. That’s partially true, because while Medicare covers some specific, part-time services associated with dementia care, it won’t pay for many of the long-term care supports your family needs. Whether you’re considering moving your loved one to a memory care community or want to help them age in place for as long as possible, it’s important to understand how Medicare works and what it covers.
Our advisors help 300,000 families each year find the right senior care for their loved ones.
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, with premiums and deductibles relative to income.
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 |
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.[03]
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 — this is 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 “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’s important to note that Medigap policies don’t cover the costs of long-term care or private-duty nursing.[04]
Our advisors help 300,000 families each year find the right senior care for their loved ones.
Medicare doesn’t 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.[02]
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 |
| Care planning to learn about treatment options | 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 |
Medical expenses can increase during the 12 months before an Alzheimer’s diagnosis.[07] So, an early diagnosis can help you cover 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.
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.[08]
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.[09]
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.[08]
Our advisors help 300,000 families each year find the right senior care for their loved ones.
In addition to skilled nursing care or assistance from a home health aide, 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, keep in mind that homemaking tasks and assistance with activities of daily living aren’t covered by Medicare.
Medicare doesn’t cover the cost of nursing home care for seniors with dementia. However, Medicaid may help pay for a nursing home level of care. If your loved one has Medicaid, they would need to live in a Medicaid-approved nursing home to take advantage of this coverage.
Because Medicare doesn’t 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, or view your state’s profile on the Medicaid website.
If you’re 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, 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. Compare Original Medicare & Medicare Advantage. 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.
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.
Make the best senior care decision