Does Medicare Cover Memory Care in 2024?

Medicare Coverage of Memory Care

Medicare and Dementia Care

Care for people with dementia or Alzheimer’s is not strictly confined to memory care communities; rather, it consists of a variety of approaches.

Medicare generally will cover the following costs related to memory care:

• Home health-care services
• Prescription medications
• Stays at an inpatient hospital or skilled nursing facility
• Hospice care
• Diagnostic tests
• Cognitive assessments and safety evaluation

Many dementia or memory care patients, however, may require assistance with activities of daily living or long-term custodial care, which is not covered by Medicare.

Medicare and Dementia Testing

Before obtaining care for dementia, it’s important to get a formal diagnosis from your physician. In these cases, Medicare Part B will cover a doctor visit that includes a cognitive impairment assessment. To perform this assessment, a doctor will observe a patient, hear concerns from the patient or family members, and conduct a formal test for cognitive impairment.

If your physician orders blood tests or brain scans for dementia and related conditions, then Medicare Part B will cover those expenses.

Medicare and Home Health Care for Dementia

Home health care sometimes can be a viable substitute for memory care services, and Medicare will pay for some of those costs. Medicare will pay for up to 35 hours a week related to home health care services for individuals certified as “homebound.”

What Medicare Won’t Cover

Medicare will not cover custodial care or nonmedical care, which includes both assistance with activities of daily living and the cost of rent at a memory care or other senior care community.

Some examples of what Medicare won’t cover include:

• Dressing assistance
• Laundry or grocery shopping
• Meal preparation
• 24/7 care

Will Medicare Cover Assisted Living for Dementia Patients?

Unfortunately, Medicare does not cover long-term care services for dementia patients at an assisted living facility. That means they won’t cover the cost of room and board or services related to personal care, but Medicare may be able to cover some health care costs you receive in an assisted living facility.

Medicare and Memory Care

An assisted living facility provides personal care and assistance with activities of daily living to seniors, whereas a memory care facility focuses on providing specific care tailored to a patient’s care plan, safety assessment, or individual diagnosis. According to Genworth, the national monthly median cost for an assisted living facility is $4,500. On average, memory care costs 30 percent more than assisted living facilities, depending on your location.

The key thing to remember with Medicare is that it only covers “medical” needs. Some facets of memory care are medical in nature (tests, medications, etc.), but the majority of support received in memory care would fall under the umbrella of personal and custodial care.

Medicare Special Needs Plans (SNPs)

As a type of Medicare Advantage Plan, Medicare SNPs tailor their benefits to the specific needs of the groups they serve. Several of these plans cater to the needs of people with dementia and Alzheimer’s. Under one of these plans, you’ll likely receive coverage for dementia-related drugs.

To be eligible for a Medicare Special Needs Plan, you must:

• Live in a nursing home or receive regular skilled nursing care.
• Be eligible for both Medicare and Medicaid.
• Have a specific chronic condition, such as diabetes or dementia.

Some Medicare Advantage plans have expanded to add in-home long-term care benefits. Check your Medicare Advantage plan to see what’s covered and keep in mind that the availability of specialized Medicare Advantage plans varies by location.

Does Medigap Cover Dementia Care?

Medigap covers similar healthcare services as Medicare, but a Medigap plan won’t pay for memory care or other custodial care that dementia patients may typically need. In general, Medigap (Medicare Supplement Insurance) pays for some of the gaps that Medicare may not cover. A Medigap plan may cover daily copays for skilled nursing facilities, coinsurance, and deductibles. In some cases, Medigap can also extend the number of days covered in a facility.

Paying for Dementia Care

Some common ways to pay for dementia-related care include long-term care insurance, aid and attendance benefits, family caregiving, and Medicaid.

Long-Term-Care Insurance

Its premiums can be expensive, but long-term-care insurance is one of the best ways to cover memory care costs. In addition to memory care, a long-term-care policy can also be used to cover assisted living, nursing homes, adult day care, and home care services.

Aid and Attendance Benefits

You can help pay for some of your memory care costs by enrolling in the Aid and Attendance Benefits program through the VA. To qualify, you need to require assistance with the activities of daily living and meet specific VA requirements.

Medicaid

Funded by states and the federal government, Medicaid offers health coverage to eligible low-income Americans. In some cases, Medicaid can help pay for some of the costs of memory care or assisted living facilities.

You may also want to apply for an HCBS waiver, which can help you pay for some of the costs related to assisted living or a nursing home. Keep in mind, however, that it won’t cover room and board costs, but it can help cover the cost of activities of daily living and medication management for patients with dementia or Alzheimer’s.

Paying for memory care can be challenging, but there are many ways to find assistance — whether it’s through long-term-care insurance or state and federal benefit programs.

To learn more about Medicare and memory care, read our helpful guides.

• Do Medicare and Medicaid Pay for Assisted Living?
• Do Medicare and Medicaid Pay for Nursing Homes?
• Alzheimer’s and Dementia Life Expectancy Calculator