Does Medicare Cover Dementia Care? 

Today in the United States, between five and seven million people have some form of dementia, and it remains a leading cause of death for seniors across the country. 

The most common type of dementia is Alzheimer’s disease, but other forms like frontotemporal, Lewy body, and vascular dementia also cause people can reduce your cognitive abilities, causing disruptions in daily life and activities. 

Some common signals of dementia include:

• Memory loss 
• Confusion
• Trouble speaking or understanding speech
• Getting lost and wandering
• Repetitive questions
• Difficulty executing normal daily activities
• Loss of balance and trouble moving around

Someone who’s diagnosed with dementia will need different levels of care as the disease progresses, and most will depend on Medicare insurance for help with medical expenses.

How does Medicare Part A cover dementia? 

Medicare provides coverage for a range of health care services involving diagnosis, treatment, and support for patients with dementia. 

Original Medicare Part A (hospital insurance)covers the following: 

• Inpatient hospital stays for care necessary to treat medical issues or acute health episodes that are associated with dementia 
• Up to 100 days in a skilled nursing facility for care that is medically necessary after a qualifying inpatient hospital stay of three days either for rehabilitation or skilled nursing care
• Home health care services (covered by both Original Medicare Part A and B) that include skilled nursing care, physical therapy, speech-language pathology, and occupational therapy
• Hospice care if the beneficiary has been diagnosed with a terminal illness (including dementia) and have a life expectancy of six months or less

Unfortunately, Medicare doesn’t cover custodial care (care involved with normal daily activities like dressing, bathing, etc.) in a nursing home, assisted living center, memory care facility, or through home health care services if it’s the only care you need. Furthermore, Medicare doesn’t cover long-term care that most dementia patients require as the disease progresses. 

Health care services that are included under Original Medicare Part A are covered after the patient pays their Part A deductible for the current benefit period. If a hospital stay is more than 60 days, the patient will be charged a copayment. As of 2024, the charges are:

• Days 1 to 60: $0
• Days 61 to 90: $371 per day
• Days 91 to 151: $742 per day
• After day 151: 100 percent of all costs

How does Medicare Part B cover dementia care?

Original Medicare Part B (medical insurance)covers the following health care services regarding dementia:

• Visits to health care providers including physicians, neurologists, psychiatrist, and other specialists necessary for dementia care
• Diagnostic tests necessary to diagnose dementia including MRIs, CT scans, blood tests, and cognitive assessments
• Mental health care services including outpatient counseling and therapy sessions with professional mental health care providers 

Original Medicare Part B pays 80 percent of the cost for visits to physicians and mental health care services, and you pay the remaining 20 percent after covering your annual Part B deductible. Part B pays 100 percent of the cost of some diagnostic exams. Your physician should let you know beforehand whether your services carry coinsurance charges. 

If you’re enrolled in Original Medicare Parts A and/or B, you must be enrolled in a stand-alone prescription drug plan (Medicare Part D) to get coverage for medications that are commonly prescribed to manage dementia symptoms. 

Medicare Advantage (Part C)plans must cover all the benefits included in Original Medicare Parts A and B. Most Part C plans also offer extended coverage, extra benefits, and prescription drugs. 

Depending on your Part C plan, you may have access to additional services like respite care for your caregiver or more days of inpatient hospital care. You may be restricted to using health care providers and medical facilities that are within the plan’s network of providers. 

If you have questions about coverage for dementia care, you should contact your plan provider for details if you can’t find the information on your printed policy or the company’s official website.