Neither Original Medicare nor Medicare Advantage plans provide coverage for stays in an assisted living facility. But what about for those with dementia? Does dementia change things?

This leads to a common question many people have is, “Does Medicare cover assisted living for dementia?” In this article, we answer that question in clear, plain English. You will also find the average costs of assisted living facilities and other helpful info.

Does Medicare Cover Assisted Living For Dementia?

The short answer is no. In most cases, Medicare will not cover the cost of staying in an assisted living facility. Even in dementia cases. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your assisted living facility. 

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for assisted living facility stay. Even if the patient has dementia and is staying in an assisted living facility, Medicare still will not provide coverage for it.

However, when it comes to dementia care, there are many services that Original Medicare does cover. Original Medicare provides the following for dementia care:

  • Inpatient stays including hospital and skilled nursing facility 
  • Home health care
  • Hospice care
  • Cognitive assessments
  • Dementia diagnosis tests

Medicare Part A provides coverage for both hospital stays and skilled nursing care for dementia. 

While you are staying in a hospital, Medicare Part A will cover a 90 day stay. After 60 days in a hospital, you will pay a copayment of $352 a day. After 90 days, Medicare Part A will no longer provide coverage for your hospital stay.

If you are staying in a skilled nursing facility for dementia care, Medicare Part A will cover up to 100 days of stay. After the 20th day, you will pay a copayment of $176 per day. After 100 days, Medicare Part A will no longer provide coverage for your skilled nursing facility stay.

Another option you have is hospice care. Medicare Part A also provides coverage for hospice care. However, they will only do so if you have a life expectancy of six months or less and if you have chosen hospice care over Medicare-approved treatments.

Both Medicare Part A and Part B also provide coverage for home health care for patients with dementia. 

Part C Coverage for Assisted Living for Dementia

Medicare Advantage plans (Medicare Part C) also do not provide coverage for assisted living facilities, even for dementia patients. Part C covers everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and your out-of-pocket costs will vary depending on the specifics of your plan. 

Medicare Advantage will only pay for the qualified medical care that you receive at the assisted living facility, not the facility itself.

How Much Does Dementia Care Cost In An Assisted Living Facility?

The cost of Alzheimer’s care in an assisted living facility may come to over $1,000 a month. This cost is on top of the regular cost of an assisted living facility which may be from $3,000 to $6,000 per month.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover Chantix?

Leave a Reply