While it can be hard knowing that your loved one has dementia, there are many options to ensure they get the care they need. However, this care can often be quite expensive.
So a common question many people have is, “does Medicare cover dementia care?” In this article, we answer that question in clear, plain English. You will also find the average costs of dementia care and other helpful info.
Does Medicare Cover Dementia Care?
The short answer is yes; Medicare will cover the cost of 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 dementia care. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for dementia care. This includes the following:
- Inpatient stays including hospital and skilled nursing facility
- Home health care
- Hospice care
- Cognitive assessments
- Dementia diagnosis tests
- Prescription drugs (covered by Medicare Part D)
Inpatient services such as your stay in a hospital and/or skilled nursing home for dementia care are covered by Medicare Part A. During your hospital stay for dementia care, Medicare Part A provides coverage for the following:
- Semi-private rooms
- General nursing care
- Additional hospital services
During the first 60 days of your inpatient stay for dementia care, Medicare Part A provides coverage for all the expenses. From days 61 to 90, Medicare still covers a portion of the cost, but you pay a copayment of $352 a day. From day 90 onwards, Medicare no longer covers your inpatient stay for dementia care.
Medicare Part A also provides coverage for skilled nursing facility stays for dementia care. Part A covers all of the expenses during your skilled nursing facility stay for the first 20 days. From days 21 to 100, Medicare still provides coverage but you will pay a copayment of $176 per day. Beyond day 100, Medicare no longer covers your skilled nursing facility stay.
Another option that Medicare Part A covers for dementia care is hospice care. Medicare Part A will only provide coverage for hospice care for those who have a life expectancy of six months or less. And also you must choose hospice care to treat symptoms of your dementia rather than other Medicare-approved treatments.
Services that Medicare Part A covers during your hospice care include:
- Doctor’s services
- Nursing care
- Medications to treat symptoms
- Short-term inpatient care to mend symptoms
- Durable medical equipment
- Medical supplies
- Counseling for you and your family
- Short-term respite care
Medicare Part A covers all the expenses of hospice services except for room and board. You may pay a copayment for medications.
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
Medicare covers all of the costs with regard to your home health services. But it will only cover 80 percent of the costs of durable medical equipment such as wheelchairs. You will pay for the remaining 20 percent.
Part C Coverage for Dementia Care
Medicare Advantage plans (Medicare Part C) also provide coverage for memory care. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan.
How Much Does Dementia Care Cost?
Home health services for people with dementia cost about $25 per hour. And nearly $75 a day for adult daycare.
Staying in an assisted living facility may cost over $4,000 a month. A private room in nursing care costs $290 a day and a semi-private room costs $255 per day.
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 home health aides?