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While it can be hard knowing that your loved one has dementia such as Alzheimer’s disease, 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 memory care?” In this article, we answer that question in clear, plain English. You will also find the average costs of memory care and other helpful info.
Does Medicare Cover Memory Care?
The short answer is yes; Medicare will cover the cost of memory 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 memory 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 memory care. Parts A and B provide coverage for some costs related to dementia. What Medicare covers for memory care include the following:
- Inpatient stays such as hospital and skilled nursing facility
- Home health care
- Hospice care
- Cognitive assessments
- Dementia diagnosis tests
- Prescription drugs (covered by Medicare Part D)
Medicare Part A provides coverage for dementia care for those who are staying in an inpatient setting such as a hospital or skilled nursing facility. In a hospital stay, Medicare Part A provides coverage for the following services:
- Semi-private rooms
- General nursing care
- Additional hospital services
Medicare Part A covers all the costs of your hospital expenses for the first 60 days of your stay. From days 61 to 90, Medicare covers a portion of the costs but you pay a copayment of $352 a day. After 90 days, Medicare Part A no longer provides coverage for your inpatient hospital stay. Part B covers doctor’s services in a hospital.
Part A also provides coverage for inpatient stays in a skilled nursing facility. Medicare covers all the costs of your stay in a skilled nursing facility for the first 20 days. From days 21 to 100, Medicare still covers a portion of the costs of your stay in the skilled nursing facility but you pay a copayment of $176 per day. After 100 days of staying in a skilled nursing home, Medicare no longer covers the costs.
Medicare Part A also provides coverage for hospice care for people with dementia. However, Medicare Part A will only provide coverage for hospice care if you have a life expectancy of six months or less and if you have chosen hospice care to treat symptoms of your dementia rather than other Medicare-approved treatments.
Medicare Part A covers all the costs of hospice services except for room and board. You may pay a copayment for medications.
Both Medicare Part A and Medicare Part B provide coverage for home health care for dementia care. These services may include:
- Part-time skilled nursing care
- Part-time hands-on care
- Social services
- Physical therapy
- Occupational therapy
- Speech therapy
Medicare covers 100 percent of the costs of home health services. However, they will only cover 80 percent of the costs of the needed medical equipment such as wheelchairs. You will pay for the remaining 20 percent.
Part C Coverage for Memory Care
Medicare Advantage plans (Medicare Part C) also provide coverage for memory care. They cover 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.
How Much Does Memory Care Cost?
Home caregiving for dementia costs around $24 per hour, and around $74 per day for adult day care services. Staying in assisted living facilities costs $4,300 per month. A private room in nursing care costs $290 per 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 vision and dental?