Does Medicare cover memory care?
If you or someone you know has challenges with Alzheimer's or other forms of dementia, memory care facilities provide specialized support in a residential setting.
Unfortunately, Medicare coverage for memory care is limited. Medicare covers the cost of certain medical services and treatments for people with memory impairments, but it doesn’t cover long-term care. Read on to learn more about what specific services are covered by Medicare.
Key takeaways:
Medicare coverage for memory care is limited. While Medicare will not cover long-term care at a memory care facility, it will cover medical services and treatments for Alzheimer’s and other kinds of dementia.
You may be able to get financial assistance for memory care from Medicaid, long-term care insurance, community organizations, and veterans benefits.
Memory care is costly even with Medicare coverage. If possible, plan ahead to make an informed decision about memory care.
What is memory care?
Memory care facilities provide structured environments where people with Alzheimer’s or other forms of dementia can live safely and engage in programs that address their needs. These long-term care facilities have trained staff, a secure and supportive space, and a daily, specialized agenda for people with memory impairments.
The difference between memory care facilities and assisted living
Both memory care and assisted living facilities are types of elderly care. In assisted living facilities, adults are generally expected to manage their own time with assistance as needed. Residents can move about freely inside and outside the place. Some assisted living facilities also provide care for people with memory challenges, but there’s often less specialized programming.
On the other hand, a memory care facility provides more structure for the daily lives of those with Alzheimer’s and other types of dementia. For the safety of the residents, memory care facilities also provide more security, alarmed doors, tracking bracelets, medication management, specialized staff, training, programing, and other extra supervision.
Because of this extra personal and specialized care, the cost of care at a memory care facility can be 20% to 30% more than in assisted living, which averages at $4,051 per month nationally.
How much memory care costs
The costs of a memory care facility can vary depending on the state you live in and the specific facility, but you can expect to pay $6,160 or more per month in the U.S. While Medicare can help pay for any medical services and treatments the facility provides, residents generally have to pay out-of-pocket for remaining memory care costs. If you’re interested in exploring memory care as an option, it’s important to research and plan as early as possible.
Does Medicare cover memory care?
Medicare won’t cover long-term care costs associated with memory care such as room and board or personal care within the facility.
Medicare does cover any medical services that the memory care facility provides and any general services needed by people with cognitive impairments.
Original Medicare and Medicare Supplement coverage
Original Medicare Part A (hospital or in-patient insurance) can cover:
The first 100 days in a skilled nursing facility following a hospital admission. Medicare also covers nursing home care, however, the care must be medically necessary and the person must not need custodial care (help with daily activities like eating and dressing).
Hospice care for people determined to have 6 months or less to live.
Original Medicare Part B can cover:
Any medical services related to treatAlzheimer’s and other kinds of dementia, including doctor visits, diagnostic tests, care planning services, and some prescription medications.
Medicare Supplement (Medigap) helps to cover any out-of-pocket expenses for services and treatments that Original Medicare doesn’t pay for (about 20% costs after you’ve met your Part B deductible).
Medicare Advantage coverage
By law, Medicare Advantage plans will cover any service and treatment that Original Medicare provides, so Medicare Advantage has the same limited coverage of memory care. When choosing a Medicare Advantage plan, it’s important to understand the downsides of Medicare Advantage plans. These plans often require prior authorization for covered services. Each plan also has different cost structures (different deductibles and coinsurance), so it’s important to know how the services you need are covered before receiving care.
Medicare Part D
Medicare Part D provides people with prescription drug coverage. You can obtain Part D coverage either through a stand-alone prescription drug plan (PDP) or through a Medicare Advantage plan that includes it. Each prescription drug plan is different and covers a different list of drugs. This is why it’s important to review the details of your Part D coverage every year to be sure the drugs you need are covered.
Resources for financial assistance
There are a few options you can explore to get coverage for memory care. Even with these resources, memory care can be expensive and getting financial assistance can be complicated. Planning ahead and talking to an elder law attorney can help you discover more about memory care.
Medicaid
Medicaid will cover some costs of memory care, including specialized memory care units in nursing homes with trained professionals who work specifically with people who have dementia. Navigating Medicaid can be a complex process depending on the state you live in. Connect with your local agency to see if you qualify.
Long-term care insurance
Long-term care insurance is a type of insurance that helps cover the costs of long-term care service facilities like nursing homes, assisted living facilities, and memory care. Certain providers can reimburse you for memory care, but check the details and understand your policy fully before buying.
Veterans benefits
Veterans who need memory care can get coverage through the VA Health System based on certain eligibility requirements.
Memory care is expensive, especially since there are limited options for coverage with Medicare. If you still have questions, we can help! Call us at (855)-900-2427 to talk to one of our licensed Advisors and get more information on what Medicare covers.