- Medicare covers some of the costs associated with dementia care, including inpatient stays, home health care, and necessary diagnostic tests.
- Some Medicare plans, such as special needs plans, are specifically geared toward people with chronic conditions like dementia.
- Medicare doesn’t typically cover long-term care, such as that provided at a nursing home or an assisted living facility.
- There are resources available, such as Medigap plans and Medicaid, that can help cover dementia care services that aren’t covered by Medicare.
Dementia is a term that’s used to refer to a state in which thinking, memory, and decision-making have become impaired, interfering with daily activities. Alzheimer’s disease is the
Keep reading to learn what parts of dementia care Medicare covers and more.
Medicare covers some, but not all, of the costs associated with dementia care. This includes:
- inpatient stays at facilities like hospitals and skilled nursing facilities
- home health care
- hospice care
- cognitive assessments
- necessary tests for dementia diagnosis
- prescription drugs (Part D)
What isn’t covered and how to help pay
Many people with dementia will need some kind of long-term care that includes custodial care. Custodial care involves help with daily activities such as eating, dressing, and using the bathroom.
Medicare doesn’t typically cover long-term care. It also doesn’t cover custodial care.
However, there are other resources that may help you to pay for long-term and custodial care. These include things like Medicaid, the Programs of All-inclusive Care for the Elderly (PACE), and long-term care insurance policies.
Medicare Part A covers inpatient stays at places like hospitals and skilled nursing facilities. Let’s look at this a little more closely.
Medicare Part A covers inpatient hospital stays. This can include facilities like acute care hospitals, inpatient rehabilitation hospitals, and long-term care hospitals. Some of the services that are covered are:
- a semi-private room
- general nursing care
- medications that are a part of your treatment
- additional hospital services or supplies
For an inpatient hospital stay, Medicare Part A will cover all costs for the first 60 days. For days 61 to 90, you’ll pay a daily coinsurance of $352. After 90 days as an inpatient, you’ll be responsible for all costs.
If you receive doctor’s services in a hospital, they’ll be covered by Medicare Part B.
Skilled nursing facilities (SNFs)
Medicare Part A also covers inpatient stays at an SNF. These are facilities that provide skilled medical care that can only be given by healthcare professionals like doctors, registered nurses, and physical therapists.
If your doctor decides that you need daily skilled care after hospitalization, they may recommend a stay at an SNF. Your stay may include things like a semi-private room, meals, and medical supplies used in the facility.
Home health care is when skilled health or nursing services are provided in the home. It’s covered by both Medicare parts A and B. These services are typically coordinated by a home health agency and can include:
- part-time skilled nursing care
- part-time hands-on care
- physical therapy
- occupational therapy
- speech-language therapy
- medical social services
In order to be eligible for home health care, the following must be true:
- You must be classified as homebound, meaning that you have trouble leaving your home without the help of another person or an assistive device like a wheelchair or walker.
- You must be receiving the home care under a plan that’s regularly reviewed and updated by your doctor.
- Your doctor must certify that you require skilled care that can be provided at home.
Medicare Part B covers two types of wellness visits:
- A “Welcome to Medicare” visit, completed within the first 12 months after Medicare enrollment.
- An Annual Wellness Visit once every 12 months in all subsequent years.
These visits include a cognitive impairment assessment. This helps your doctor look for potential signs of dementia. To do this, your doctor may use one or a combination of the following:
- direct observation of your appearance, behaviors, and responses
- concerns or reports from yourself or family members
- a validated cognitive assessment tool
Hospice is a type of care that’s given to people who are terminally ill. Hospice care is managed by a hospice care team and may include the following services:
- doctor’s services and nursing care
- medications to help ease symptoms
- short-term inpatient care to help manage symptoms
- medical equipment like walkers and wheelchairs
- supplies like bandages or catheters
- grief counseling for you or your family
- short-term respite care, which is a short inpatient stay to allow your primary caregiver to rest
Medicare Part A will cover hospice care for someone with dementia if all of the following are true:
- Your doctor has determined that you have a life expectancy of six months or less (although they can adjust this if necessary).
- You agree to accept care focused on comfort and symptom relief instead of care to cure your condition.
- You sign a statement indicating that you select hospice care as opposed to other Medicare-covered interventions.
Medicare will pay all costs for hospice care, except for room and board. You may also sometimes be responsible for a small copayment for any medications prescribed to help relieve symptoms.
Let’s do a quick review of the parts of Medicare that cover dementia care:
Medicare coverage by part
|Medicare Part A
|This is hospital insurance and covers inpatient stays at hospitals and SNFs. It also covers home health care and hospice care.
|Medicare Part B
|This is medical insurance. It covers things like doctor’s services, medical equipment, and services necessary to diagnose or treat a medical condition.
|Medicare Part C
|This is also referred to as Medicare Advantage. It has the same basic benefits as Parts A and B and may offer additional benefits like dental, vision, and prescription drug coverage (Part D).
|Medicare Part D
|This is prescription drug coverage. If you’re prescribed medications for your dementia, Part D may cover them.
|This is also called Medigap. Medigap helps to pay for costs that aren’t covered by Parts A and B. Examples include coinsurance, copays, and deductibles.
To be eligible for Medicare coverage for dementia, you must meet one of the general Medicare eligibility criteria. These are that you’re:
However, there are also some specific Medicare plans that people with dementia may be eligible for. In these cases, a diagnosis of dementia may be required:
- Special needs plans (SNPs): SNPs are a special group of Advantage plans that specifically address the needs of people with specific health conditions, including dementia. Coordination of care is also often included.
- Chronic care management services (CCMR): If you have dementia and at least one more chronic condition, you may be eligible for CCMR. CCMR includes development of a care plan, coordination of care and medications, and 24/7 access to a qualified healthcare professional for health needs.
Dementia happens when you lose cognitive abilities like memory, thinking, and decision-making. This can significantly impact social function and activities of daily living. For example, a person with dementia may have difficulty:
- recalling people, old memories, or directions
- carrying out daily tasks independently
- communicating or finding the right words
- solving problems
- staying organized
- paying attention
- controlling their emotions
There isn’t just one type of dementia. There are actually several types, each with different characteristics. They include:
Medicare covers some parts of dementia care. Some examples include inpatient stays at a skilled nursing facility, home health care, and medically necessary diagnostic tests.
Additionally, people with dementia may be eligible for specific Medicare plans that are tailored to their specific needs. These include things like special needs plans and chronic care management services.
While many people with dementia need some sort of long-term care, Medicare typically doesn’t cover this. Other programs, such as Medicaid, can help to cover the costs of long-term care.