About Senior Health
Explore senior health articlesAbout Senior Care Options
Explore senior living articlesAbout Finances & Legal
Explore finances and legal articlesAbout Products for Seniors
Explore products for seniors
Does Medicare Cover Dementia Care?
Written by Kevin Ryan
about the author
3 minute readLast updated April 17, 2023
Caring for an elderly loved one with dementia can be complicated for any family. As the condition progresses, families are forced to find more advanced levels of care for their loved ones while facing increased costs. However, Medicare can help to pay for certain care needs. While it won’t cover room and board at senior living communities, it may pay for qualified medical services and temporary stays at a skilled nursing facility for eligible individuals.
Key Takeaways
- Medicare doesn’t cover room and board in senior living communities. This includes memory care, assisted living, and nursing home facilities.
- Memory care supports families and their loved ones living with dementia. Memory care support can be received in a residential setting or through nonresidential community resources.
- Medicare is federal health insurance for seniors or individuals with disabilities or certain illnesses. Original Medicare is administered by the federal government, while Medicare Advantage plans are available from private insurance companies.
- Medicare can help seniors with dementia by paying for some medical care. Medicare will cover services such as cognitive assessments, care planning, and hospital stays for qualified seniors.
What is memory care?
Memory care communities provide specialized support for seniors living with dementia or cognitive decline. Some families may opt to care for their loved ones in their own homes with the support of professional in-home care or an adult day care center. Dementia care can be provided in different settings to help seniors maintain their independence for as long as possible. However, memory care communities also provide secure environments to prevent wandering as well as therapies and activities to help slow decline and encourage social engagement.
What is Medicare?
Medicare is the federal health insurance program for people age 65 or older, and younger people with certain disabilities, end-stage renal disease, or amyotrophic lateral sclerosis (ALS).[01]
Let our care assessment guide you
Our free tool provides options, advice, and next steps based on your unique situation.
Original Medicare
Original Medicare consists of two distinct parts that cover different types of care.- Part A (hospital insurance) helps cover inpatient stays at a hospital or skilled nursing facility and home health care.
- Part B (medical insurance) focuses on medically necessary services a patient may receive from a doctor or other medical professionals. It may also cover some preventative services and medical equipment a patient may need.
Medicare Advantage
Another option, Medicare Advantage, offers the same basic coverage as Original Medicare but through private insurance providers. These plans may offer additional benefits, but they can also come with their own set of restrictions.Does Medicare cover memory care?
Medicare will cover some aspects of dementia care for qualified individuals; however, it will not pay for the room and board costs of living in a memory care community. While each family’s circumstances differ, the following provides an overview of the dementia care that Medicare will cover and what it will not. Covered by Medicare: Not covered by Medicare:
- Cognitive assessments
- Home safety evaluations
- Planning for care
- Hospital stays
- Prescription medications (additional coverage is available through Medicare Part D)
- Home health care
- Temporary stays in a skilled nursing facility
- Hospice care [02]
- Room and board in a memory care community
- Long-term care
- Therapies such as massage, acupuncture, and herbal medicines
- In-home support with activities of daily living (if it is the only care needed) [03]
Talk with a Senior Care Advisor
Our advisors help 300,000 families each year find the right senior care for their loved ones.
Does Medicare cover home health care for dementia?
Yes, Medicare covers home health care for seniors living with dementia as long as they meet certain eligibility requirements. Qualified individuals may be able to receive up to 35 hours of home health care services provided by a medical professional, such as a registered nurse (RN) or a licensed occupational therapist, per week.[02]
Does Medicare cover nursing home care for dementia?
Long-term care in a memory care community or a nursing home is not covered by Medicare. However, it will cover short-term stays in a Medicare-certified skilled nursing facility for medically necessary care outlined in a patient’s care plan.[04]
Does Medicare cover assisted living for dementia?
No, Medicare will not cover the cost of room and board or personal care services at an assisted living facility. In certain circumstances, however, a qualified beneficiary living in an assisted living community may be able to receive temporary support with activities of daily living if they’re also receiving home health care services as prescribed by a doctor.[02]
Other payment options and resources for families
Because dementia is a progressive condition, it’s important to begin planning for your loved one’s care as early as possible. Medicare doesn’t cover long-term memory care, but there are several ways to pay for senior care, including Medicaid, veterans benefits, long-term care insurance, and funds from a life insurance policy. Navigating Medicare can be challenging, but the official Medicare site offers support for signing up and understanding the coverage your loved one may qualify for. For assistance with finding a memory care community or home care agency, contact a Senior Care Advisor. As senior living experts, they can provide guidance while helping you find the care that fits your loved one’s needs.
Recommended For You
References
Medicare.gov. Parts of Medicare.
Centers for Medicare and Medicaid Services. (2023, March). Medicare and Home Health Care.
Medicare.gov. What’s not covered by Part A and Part B?
Medicare.gov. Skilled nursing facility (SNF) care.
The information contained in this article 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 (of which OurParents is a trademark) 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 recommend or endorse the contents of the third-party sites.
OurParents is a trademark of A Place for Mom. A Place for Mom is paid by our participating communities, therefore our service is offered at no charge to families. Copyright © 2023 A Place for Mom, Inc. All Rights Reserved.