Medicare covers some of the costs of dementia care, such as inpatient stays, home healthcare, and some diagnostic tests. Medicare Special Needs Plans and Medigap may work with Medicaid to help as well.
The term “dementia” refers to a state in which thinking, memory, and decision making have become impaired, interfering with daily activities. Alzheimer’s disease is the
According to a 2019 research review, 5.4 million people in the United States have Alzheimer’s disease or another type of dementia, and about 96% of those people are 65 years old or older.
Keep reading to learn what parts of dementia care Medicare covers and more.
Medicare covers some but not all costs associated with dementia care, including:
- inpatient stays at facilities such as hospitals and skilled nursing facilities (SNFs)
- home healthcare
- hospice care
- cognitive assessments
- tests necessary for a dementia diagnosis
- prescription drugs (Medicare Part D)
What isn’t covered and how to help payMany 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, other resources are available and may help you pay for long-term and custodial care. Examples include Medicaid, the Program of All-Inclusive Care for the Elderly (PACE), and long-term care insurance policies.
Medicare Part A covers inpatient stays at hospitals and SNFs. Let’s look at this a little more closely.
Hospitals
Medicare Part A covers inpatient hospital stays. This can include stays in facilities such as acute care hospitals, inpatient rehabilitation hospitals, and long-term care hospitals. Some of the services that are covered are:
- a semiprivate room
- meals
- 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 through 90, you’ll pay a daily coinsurance of $408.
Inpatient hospital days 91 to 150 have a coinsurance of $816 per day. After 151 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.
SNFs
Medicare Part A also covers inpatient stays at SNFs. These are facilities that provide skilled medical care that can be provided only by healthcare professionals such as 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 semiprivate room, meals, and medical supplies used in the facility.
Home healthcare is skilled health or nursing services that are provided in your home. It’s covered by Medicare Parts A and B. These services are typically coordinated by a home health agency and can include:
- part-time skilled nursing care
- physical therapy
- occupational therapy
- speech-language therapy
- medical social services
For you to be eligible for home healthcare, 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 receive home care under a plan that is regularly reviewed and updated by your doctor.
- Your doctor must certify that you require skilled care that can be provided at home.
Medicare covers all home health services. If you need medical equipment such as a wheelchair or a hospital bed, you’ll be responsible for 20% of the cost.
Medicare Part B covers two types of wellness visits:
- a “Welcome to Medicare” visit that’s 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, which helps your doctor look for potential signs of dementia. To do this, your doctor may use one or more 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 care is a type of care for people who are nearing the end of life as a result of a health condition. Hospice care is managed by a hospice care team and may include the following services:
- doctors’ services and nursing care
- medications to ease symptoms
- short-term inpatient care to help manage symptoms
- medical equipment like walkers and wheelchairs
- supplies like bandages and 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
If you have dementia, Medicare Part A will cover hospice care if all of the following are true:
- Your doctor has determined that you have a life expectancy of 6 months or less (although they can adjust this if necessary).
- You agree to accept care that’s focused on comfort and symptom relief instead of care to cure your condition.
- You sign a statement indicating that you select hospice care rather than 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 | Services covered |
|---|---|
| Medicare Part A | This is hospital insurance and covers inpatient stays at hospitals and SNFs. It also covers home healthcare 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 called Medicare Advantage. It has the same basic benefits as Parts A and B and may offer additional benefits such as 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. |
| Medicare Supplement | This is also called Medigap. Medigap helps pay for costs that aren’t covered by Parts A and B, such as coinsurance, copays, and deductibles. |
To be eligible for Medicare coverage for dementia, you must meet one of these general Medicare eligibility criteria:
- You are 65 years old or older.
- You are at any age and have a disability.
- You are at any age and have end stage renal disease
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 certain health conditions, including dementia. Coordination of care is also often included.
- Chronic care management (CCM) services: If you have dementia and at least one other chronic condition, you may be eligible for CCM, which includes developing a care plan, coordinating care and medications, and 24/7 access to a qualified healthcare professional for health needs.
Dementia happens when you lose cognitive abilities such as memory, thinking, and decision making. This can significantly affect your social functioning and ability to complete activities of daily living. For example, you may have difficulty:
- recalling people, memories, or directions
- carrying out daily tasks independently
- communicating or finding the right words
- solving problems
- staying organized
- paying attention
- controlling your emotions
There isn’t just one type of dementia. There are several types, and each has different characteristics. The types are:
- Alzheimer’s disease
- Lewy body dementia
- frontotemporal dementia
- vascular dementia
- mixed dementia, which is a combination of two or more dementia types
Medicare covers some parts of dementia care, including inpatient stays at a skilled nursing facility, home healthcare, and medically necessary diagnostic tests.
Additionally, people with dementia may be eligible for specific Medicare plans that are tailored to their needs, such as 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 that. Other programs, such as Medicaid, can help cover the costs of long-term care.