Medicare and Dementia: Options for Care, Assisted Living, and More
Alzheimer’s and other forms of dementia make life more challenging for 5.8 million Americans and their loved ones. Depending on the level of impairment and memory loss, people with dementia often need daily care to ensure their safety.
Medicare covers dementia screenings, medication, home health care, and hospice care. However, Medicare does not cover long-term assisted living care. We’ll explain whatMedicare does and doesn’t cover in more detail in this guide.
Key takeaways:
Medicare covers services to diagnose and manage the symptoms of dementia, like screenings, medications, and occupational and physical therapy.
While Medicare covers home health and hospice care under certain situations, it doesn’t cover long-term care at a nursing home facility.
What is dementia?
Dementia is a broad term to describe a group of symptoms associated with many diseases, including Alzheimer’s disease. Diseases that are classified as dementia have symptoms in common, like:
Decline in cognitive function
Confusion
Impaired judgment
Personality changes
Problems with daily activities
Memory loss
Difficulties with thinking, problem-solving, and language
Other common conditions that can lead to dementia include vascular dementia, Lewy body dementia, and frontotemporal dementia, but Alzheimer’s disease accounts for 60-80% of cases.
Symptoms of dementia are often progressive, meaning that they worsen over time. Healthcare professionals typically diagnose dementia with a thorough medical evaluation, which can include:
Evaluating your medical history
Reviewing your medications
A physical examination
Cognitive tests
Brain imaging studies
While there is no cure for most types of dementia, treatments and exercises can help manage symptoms and improve a person’s quality of life. Common strategies to manage dementia include:
Medications to temporarily relieve symptoms or slow down the progression of symptoms
Occupational therapy and cognitive stimulation programs
Behavioral and psychological therapy
Supportive care from caregivers, friends, family, and community resources
What services does Medicare cover for dementia?
There are a few different services that Medicare covers to diagnose and treat people with dementia. From prescription drugs to different forms of therapy, take a deeper look at these coverage options.
Cognitive screenings and care plan services
During your annual Medicare Wellness visit, your healthcare provider may screen you for symptoms of dementia and Alzheimer’s disease. They’ll check for signs of cognitive impairment, memory loss, difficulty speaking or concentrating, and other common symptoms. To perform the assessment, you can expect your doctor to:
Review your medical history and medications
Ask about social supports and caregiving options
Create a care plan to manage symptoms
Direct you to a specialist for scanning
Refer you to rehabilitation services, adult day health services, and support groups
For these cognitive assessment and care plans, you pay 20% of the Medicare-approved amount for the service after you meet your Part B deductible.
Prescription drugs
If you are diagnosed with dementia, it’s important you have a prescription drug plan that helps pay for the medications you need to treat symptoms. Fortunately, all Medicare Part D plans are required to cover at least two cholinesterase inhibitors to treat and manage Alzheimer’s disease and other types of dementia.
Occupational and physical therapy
People with dementia often benefit from occupational and physical therapy. These therapies can improve motor function and help you with daily activities like dressing or bathing. Occupational and physical therapy are both covered by Medicare. You’ll pay 20% of the cost after you’ve met your Part B deductible.
Does Medicare cover home health care for dementia?
Medicare covers many medical services for dementia patients, but that’s often not all that’s needed to manage the condition. You may have questions about home health, nursing home, hospice, and assisted living care coverage for dementia. We explain how coverage works for each below.
Home health care for dementia patients on Medicare
To start, what is home health care? Home health care involves services a healthcare professional provides in your home because of an injury or chronic condition. Home health care can help you manage your dementia and slow its progression if you’re unable to leave your home.
Does Medicare cover home health care for dementia? Medicare has certain requirements you must meet to receive coverage for home health care. You must be homebound due to an illness or injury and your doctor must recommend that you don’t leave your home. If dementia prevents you from leaving your home, you can get home health care services covered.
Services may include:
Medically necessary part-time or intermittent skilled nursing care
Physical therapy
Occupational therapy
Speech-language pathology services
Medical social services
Part-time or intermittent home health aide care (only if you’re also getting skilled nursing care at the same time)
Injectable osteoporosis drugs for women
Durable medical equipment or medical devices
Medical supplies to use at home
If you don’t need medical equipment, home health care services are completely paid for. If you do need medical equipment, you’ll pay 20% of the cost for the devices after you meet your Part B deductible.
Medicare guidelines for dementia hospice care
In general, Medicare covers hospice care for people who are terminally ill and are not accepting treatment to cure an illness. People with dementia that meet these requirements can get hospice care covered.
You can receive hospice care in various locations, like your home, nursing home, or inpatient hospice facility. Medicare will cover all costs of hospice care including doctor’s services, medical supplies, and grief-counseling for you and your family.
Keep in mind that you may have to pay for room and board if you choose to receive hospice care at a nursing home (which Medicare does not cover). You’ll also have a copayment of $5 for each outpatient prescription drug, and you could have to pay 5% of the cost for hospice care received in a hospital.
Does Medicare cover nursing home care and assisted living for dementia?
Unfortunately, Medicare doesn’t cover long-term stays at a nursing home or assisted living community for dementia, or any condition. Medicare covers up to 100 days in a skilled nursing facility if you need rehabilitation after a three-day hospital stay due to an injury or emergency, but Medicare doesn’t cover long-term care. This is because the insurance doesn’t cover any custodial care (help with bathing, dressing, eating, etc) if it’s the only kind of service you need.
Understanding your healthcare benefits for dementia
Whether you have dementia or you’re providing the essential services of a caregiver, dementia is a tough battle to go through. Knowing your options for healthcare and what benefits you or a loved one can receive can give you some peace of mind. If you need help figuring out which services are covered by Medicare for dementia, call one of our licensed Medicare Advisors at 855-900-2427 or schedule a time to chat today.