Does Blue Cross Blue Shield Cover Memory Care?

Reviewed By: Gene Altaffer

Blue Cross Blue Shield (BCBS) doesn’t typically cover a stay in a memory care facility, but it may pay for some medical costs associated with dementia. The specialized services offered by these communities, such as low staff-to-resident ratio and special dementia programming, come at a cost. With monthly fees averaging $5,625, memory care is around 25% more expensive than regular assisted living. One in three Americans have health care coverage from BCBS, and many assume their policy will help pay for memory care. However, the reality can be very different.

Although BCBS plans vary by state, they typically offer Medigap and Medicare Parts C (Medicare Advantage) and D, with coverage as follows:

• BCBS Medigap: Pays the costs associated with having Medicare coverage, such as premiums, deductibles and coinsurance
• BCBS Medicare Part D: Reduces the cost of prescription medications
• BCBS Medicare Advantage: Includes the same coverage as Medicare Parts A and B. Many policies also include Part D, wellness programs and vision and hearing services.

Any dementia-related care is only covered under BCBS Medicare Advantage. Unfortunately, it won’t pay for the day-to-day expenses of a memory care facility, such as bed and board and assistance with the activities of daily living. However, it may help with:

• Inpatient hospital treatment
• General nursing care
• Prescription medications
• Testing to confirm cognitive decline
• A 20-day stay in a skilled nursing facility. Days 21-100 are subject to coinsurance payments.
• Doctor appointments
• Hospice care

Although not available in every state, Blue Cross Blue Shield Long-Term Care Insurance (LTCI) can help seniors pay for a stay in a memory care facility. However, it should be noted that these policies take pre-planning, as they need to be taken out long before the appearance of dementia symptoms.

Acceptance criteria is often very strict, but seniors accepted onto an LTCI plan pay monthly premiums and receive benefits once they can no longer perform the activities of daily living or become cognitively impaired.

As plans vary by state, always contact BCBS directly to find out whether long-term care insurance is available in a particular region.

When no BCBS plan is available to cover memory care, seniors must find other ways to pay for services, such as cashing in on life insurance policies, selling a home or other assets or using retirement benefits such as IRAs, annuities and reverse mortgages.

Some financial assistance may also be available from local organizations and non-profits, such as the Alzheimer’s Association, local churches and fraternal organizations.