Quick Answer
Medicare does not cover long-term memory care facility costs. Memory care is considered custodial care, which Medicare explicitly excludes. However, Medicare does cover medically necessary services for dementia patients including physician visits, short-term skilled nursing facility care, home health, and hospice. Families typically rely on Medicaid, long-term care insurance, or personal savings to cover memory care facility costs.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Memory Care Facility (Room & Board) | Not Covered | Medicare does not cover custodial care - ongoing supervision and personal care in a memory care facility |
| Medicare Part B (Outpatient) | Covered | Covers physician visits, cognitive assessments, outpatient therapy, and care planning |
| Medicare Part A (SNF) | Partial | Covers short-term skilled nursing facility care up to 100 days following a qualifying hospital stay |
| Medicare Part A (Hospice) | Covered | Covers hospice care when life expectancy is 6 months or less |
| Medicare Advantage (Part C) | Varies | Some plans offer supplemental benefits like caregiver support or adult day care |
| Medicaid | May Cover | Medicaid covers long-term custodial care for those who meet income and asset requirements |
Understanding Your Coverage Options
Memory Care Facilities - What Medicare Covers and Doesn't
Custodial care is excluded from MedicareMemory care facilities are specialized residential settings for people with Alzheimer's disease, dementia, and other cognitive conditions. They provide 24-hour supervision, secured environments, and assistance with daily activities such as bathing, dressing, and eating.
Medicare classifies this type of care as custodial care - help with daily activities that does not require a licensed medical professional. Medicare explicitly excludes custodial care from coverage, regardless of the setting.
The average cost of memory care in the United States ranges from $4,500 to $7,000 per month. Without coverage, this becomes one of the most significant financial burdens a family can face.
What It Doesn't Cover
- Room and board in a memory care facility
- 24-hour supervision and secured environment costs
- Personal care assistance (bathing, dressing, eating)
- Non-skilled companion care or supervision
Memory care facilities typically cost $4,500–$7,000/month. Medicaid may cover these costs for those who qualify based on income and assets.
The Coverage Gap
Medicare's most significant limitation for dementia patients is the custodial care exclusion. Once a patient no longer needs skilled medical services, Medicare coverage ends - even if they still require 24-hour supervision in a memory care facility.
Medicare Part B (Outpatient Services)
Covered for medically necessary servicesMedicare Part B covers the outpatient medical services that dementia patients use regularly. This includes visits to physicians and neurologists, cognitive assessments, outpatient mental health services, and medically necessary therapy.
Part B also covers the cognitive impairment care planning benefit - a comprehensive visit where your physician develops a written care plan for your diagnosis. This is covered at no cost-sharing with a participating provider.
What It Covers
- Physician and specialist visits
- Cognitive assessments and neuropsychological testing
- Comprehensive care planning for cognitive impairment
- Outpatient mental health services
- Speech, occupational, and physical therapy
- Home health services ordered by a physician
- Durable medical equipment
What It Doesn't Cover
- Memory care facility room and board
- Non-skilled personal care or supervision
You pay 20% coinsurance after the $283 annual Part B deductible. A Medigap plan can eliminate this cost-sharing.
Medicare Part a (Skilled Nursing & Hospice)
Covered for short-term skilled care and hospiceMedicare Part A covers short-term skilled nursing facility (SNF) care following a qualifying hospital stay of at least 3 days. Medicare covers days 1–20 in full, and days 21–100 with a $217/day coinsurance. After 100 days, coverage ends.
For end-stage dementia, Medicare Part A covers hospice care when two physicians certify a life expectancy of 6 months or less. Hospice provides comfort-focused care including nursing visits, aide services, medications for comfort, and respite care for family caregivers.
What It Covers
- Short-term skilled nursing facility care (up to 100 days per benefit period)
- Skilled nursing, therapy, and wound care in a SNF
- Hospice care for terminal dementia diagnosis
- Inpatient hospital stays for acute medical conditions
What It Doesn't Cover
- Long-term memory care facility stays
- SNF care beyond 100 days per benefit period
- Custodial care without a skilled nursing need
SNF: $0 for days 1–20, $217/day for days 21–100. Hospice: covered in full with small copays for medications and respite care.
Frequently Asked Questions
Does Medicare Pay for Memory Care Facilities?
No. Medicare does not cover the room and board costs of memory care facilities. This is considered custodial care, which Medicare excludes. Medicare only covers medically necessary skilled care.
How Long Will Medicare Pay for a Nursing Home for Dementia?
Medicare covers up to 100 days of skilled nursing facility care per benefit period following a qualifying 3-day hospital stay. Days 1–20 are fully covered; days 21–100 require a $217/day coinsurance. After 100 days, Medicare coverage ends.
Does Medicaid Cover Memory Care?
Yes, Medicaid can cover long-term memory care facility costs for those who meet income and asset eligibility requirements. Medicaid rules vary by state, so contact your state Medicaid office for details.
What is the Difference between a Nursing Home and Memory Care?
Memory care facilities are specialized units or standalone facilities designed specifically for people with dementia. They offer secured environments, specialized staff, and dementia-focused programming. Nursing homes provide broader skilled and custodial care for various conditions.
Does Medicare Cover In-home Dementia Care?
Medicare covers skilled home health services (nursing visits, therapy) when ordered by a physician for a homebound patient. Non-skilled personal care or companion care at home is not covered by Medicare.
David Haass
AuthorDavid Haass is a licensed Medicare insurance agent with years of experience helping beneficiaries understand their coverage options.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare.