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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, Medicare never covers respite care. If you need in-home caregiver services you can expect to pay for those yourself. Now, there are somethings Medicare will help with such as screenings, psychological services, and care planning. Also, those with Part D will have medication coverage.

How Does Medicare Cover Dementia

While 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?

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?

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?

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

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

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. 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. 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

Advantage plans must offer the same benefits as 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 Medicare.

Advantage plans could benefit dementia patients:

  • A Medicare 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.

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

Do Medigap Plans Cover Dementia

Medigap plans cover the same healthcare services like Medicare. That means a Medigap plan won’t pay for assisted living or in-home help. But, a Medigap plan can pick up where Medicare leaves off when it comes to paying for doctors and 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:

  • 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.

FAQ’s

Does Medicare cover respite care?
Respite care gives caregivers a short break. 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?
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. Part B covers specialist visits and additional testing.
Does Medicare cover long term memory care?
Medicare doesn’t cover long-term memory care. But, it will cover medical costs for someone in long-term care.

How Can Medigap Help with Dementia

Medigap plans will cover the coinsurance payments you’d otherwise be responsible for paying. Our 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!

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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