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What Does Medicare Cover for Dementia Patients?

Dementia patients with Medicare can expect coverage for medical services such as inpatient care and doctors’ visits. But, Original Medicare never covers respite care. If you need in-home caregiver services you can expect to pay for those yourself.

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Now, there are somethings Medicare will help with such as screenings, psychological services, and care planning. Also, those with Medicare Part D will have prescription drug coverage.

How Does Medicare Cover Dementia?

While Original Medicare does cover a lot of medical services, the federal insurance program isn’t the most comprehensive. Most services have limitations and specific requirements that must be met for coverage. If you don’t meet the terms, Medicare won’t pay.

Does Medicare Cover Dementia Testing?

Original Medicare does cover dementia testing. In fact, health laws require doctors to cover cognitive function screenings during the Annual Wellness Visit.

Does Medicare Cover Dementia Care?

Original Medicare doesn’t cover non-medical care such as activities of daily living, custodial care, and rent. Dementia patients may need help with activities of daily living such as managing medications, getting dressed, and preparing meals.

Does Medicare Pay for Home Health Care for Dementia Patients?

Original Medicare covers some types of home health services, such as intermittent skilled nursing care as well as physical, occupational, and speech therapy. But, Original Medicare only covers services that a doctor orders at a certified home health agency.

Original Medicare won’t cover:

  • Help with bathing, dressing, or other care needed
  • Meals
  • Help with shopping, laundry, or errands
  • Round-the-clock care

Does Medicare Cover Assisted Living Facilities for Dementia Patients?

Assisted living facilities are a popular choice. Most assisted living facilities charge rent and a fee based on the assistance a resident needs.

Original Medicare doesn’t cover assisted living rent nor does it cover fees for personal care. Yet, Original Medicare will cover healthcare you get in assisted living.

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Does Medicare Cover Memory Care Facilities?

Many assisted living facilities also have memory care wings. There are also standalone memory care facilities.

Memory care units are designed to meet the needs of people with Alzheimer’s and other dementias.

They are usually more expensive than standard assisted living. Original Medicare treats memory care the same as assisted living. It only covers medical expenses, not rent, meals, or assistance.

Does Medicare Cover Hospice for People Who Have Dementia?

Hospice brings in a team of healthcare professionals to manage your care at the end of life. Medicare Part A will pay for hospice, but your doctor must certify that you have six months or less to live.

Hospice can bring relief to patients and their caregivers in the late stages of dementia. But, it isn’t a long-term solution for a dementia patient who is still relatively healthy.

Does Medicare Advantage Cover Dementia?

Medicare Advantage plans must offer the same benefits as Original Medicare. That means you can expect your Medicare Advantage plan to cover an annual dementia screening as well as medical costs.

Medicare Advantage plans come with deductibles, copays, and doctor networks, so your costs may be different than if you had Original Medicare.

Medicare Advantage plans could benefit dementia patients:

  • A Medicare Advantage Special Needs Plan for dementia is tailored to the needs of dementia patients.
  • Some Medicare Advantage plans may offer in-home long-term care benefits beyond what’s available under traditional Medicare. These benefits might include adult daycare, nutrition services, or in-home caregiving.

Medicare Advantage plans vary by location. Plans geared toward dementia and long-term care may or may not be available in your area.

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Do Medigap Plans Cover Dementia?

A Medicare Supplement (Medigap) Plan covers the same healthcare services like Original Medicare. That means a Medigap plan won’t pay for assisted living or in-home help.

But, a Medigap plan can pick up where Original Medicare leaves off when it comes to paying for doctors and Original Medicare-covered home health. Also, the Medigap plan can pay the daily copay for a stay in a skilled nursing facility and extend the number of covered days of care.

How Do I Pay for Dementia Care?

With limited Medicare coverage, families of dementia patients often wonder how to pay for care.

Here are common approaches on how you can pay for dementia care:

  • Long-term care insurance may cover in-home care or the cost of a long term care facility
  • Veterans and their spouses may be eligible for a monthly Aid and Attendance benefit
  • Family members may pitch in by doing the caregiving themselves or paying for care
  • Medicaid, the state insurance program for people with limited assets and income, will pay for a nursing home if the person with dementia qualifies. In some states, Medicaid will pay for assisted living. Medicaid may also help with in-home caregiving costs.


Does Medicare cover respite care?
Respite care gives caregivers a short break. Original Medicare’s hospice benefit includes respite care in a hospital or skilled nursing facility. Respite care is available on an occasional basis for up to five days at a time.
Does Medicare cover dementia testing?
Original Medicare covers dementia screening by your primary care doctor at no cost to you. Based on the results, your doctor may refer you to a specialist for a more in-depth evaluation. Medicare Part B covers specialist visits and additional testing.
Does Medicare cover long term memory care?
Original Medicare doesn’t cover long-term memory care. But, it will cover medical costs for someone in long-term care.

Medigap Can Help with Dementia

Medigap plans will cover the coinsurance payments you’d otherwise be responsible for paying. Our licensed Medicare agents can help you find a policy that makes sense for your situation. Give us a call at the number above to learn about your rates today! Or, fill out an online rate form to see your rates now!

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare educator serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.

6 thoughts on "What Does Medicare Cover for Dementia Patients?"

  1. So, it seems that Medicare thinks caregivers need a break only when a dementia patient has 6 months or less to live. Dementia patients need around the clock care long before then, and it’s very expensive to pay private companies, e.g., Home Instead, Incredicare, etc. People on Medicare have paid into it all their working lives, and as a taxpayer, myself, I find it inexcusable that Medicare doesn’t offer more aid to dementia patients and their caregivers. I have seen the toll caregiving exacts on caregivers in the years leading up to that 6 month hospice window. Medicare should re-evaluate and offer respite care assistance to dementia patients and their families before hospice care is needed. If someone responds to this – I want to address LTC insurance – there are many LTC insurance plans that expire at 80 years old, and those on retirement income will have a difficult time paying the high premiums for a new plan; moreover, the family cannot always afford to pay/help pay that premium. Medicare, of course, cannot solve that problem; however, it could help ease the burden placed on caregivers of dementia patients if Medicare would provide aid for respite care outside of the 6 month hospice window.

    1. You are absolutely correct. I find myself in this predicament right now, I am the sole caretaker for my 95 year old grandfather. I was fortunate enough to be able to take 2 years off and stay with him, but I am at the point that I need to start working again but have been unsuccessful in finding assistance to care for him at least 2 days a week. (The cost to do that is more than what I would make working the job). it’s a catch 22. frustrated and feel hopeless).

    2. I agree 100% my wife has dementia in about the 5 or 6 stage. I am 24/7 with no respite care. Something needs to change!!


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