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does Medicare cover dementia care at home

Does Medicare Cover Dementia Care At Home?

The primary treatment for Alzheimer’s and other types of dementia is caregiver care. Having an in-home caregiver to care for a loved one with dementia can be life-changing. Both for you and your loved one. However, caregiver care can be quite expensive.

So a common question many people have is, “does Medicare cover dementia care at home?” In this article, we answer that question in clear, plain English. You will also find the average costs of home dementia care and other helpful info.

Does Medicare Cover Dementia Care At Home?

The short answer is yes; Medicare will cover the cost of home dementia care. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your home-based dementia care. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for home-based dementia care. Both Medicare Part A and Part B provide coverage for home health care for your dementia. Here are the services that you may receive during your home healthcare: 

  • Part-time skilled nursing care
  • Part-time hands-on care
  • Social services
  • Physical therapy
  • Occupational therapy
  • Speech therapy

But for Medicare Part A and Part B to provide coverage for your home health care for dementia, these conditions have to be followed:  

  • You cannot leave your home unless you need to go on a short outing such as visiting your doctor. Medicare will still cover your home health care even if you go to an adult daycare
  • Your healthcare provider ordered that you need home health care. He/she must write an outline for the kind of care that you need. Your healthcare provider is required to regularly update and review the plan that he/she provided
  • Your healthcare provider must ascertain that you are homebound

Medicare covers all of the costs with regard to your home health services. But they will only cover 80 percent of the costs of your needed durable medical equipment such as wheelchairs. You will pay for the remaining 20 percent. 

Part C Coverage for Dementia Care at Home

Medicare Advantage plans (Medicare Part C) also provide coverage for home-based dementia care. Pact C plans cover everything Original Medicare covers. But they offer some additional benefits too. What each plan covers and how much you have to pay out of pocket for this coverage will vary depending on the specifics of your plan.

How Much Does Home-Based Dementia Care Cost?

Caregiving coming from a home health aide for home-based dementia care can cost you over $20 per hour. For around 40 hours per week, in-home caregiver care costs an average of $4,000 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 UroLift procedure?

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