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Does Medicare Cover Memory Care?
Date Updated: July 26, 2024
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Kaia Koglin has been writing professionally since 2011. She creates informative content about health care and senior living. She’s explored mental health, senior finances, assisted living and other care options, and government aid programs, and loves knowing her work helps people access the assistance they need.
Medicare does not cover the cost of memory care. Services covered by Medicare must be medically necessary, while most memory care services are considered “custodial.” This means that room and board, living costs and assistance with activities of daily living aren’t covered. However, despite not covering long-term care, Medicare may pay for certain services associated with an Alzheimer’s disease or dementia diagnosis. This can help seniors budget for other memory care costs.
Which memory care services are covered by original Medicare Part A?
Original Medicare, also known as Part A and Part B, may cover some services needed by a person with Alzheimer’s disease or dementia. Medicare Part A is hospital and inpatient insurance. It does cover up to 100 days of nursing home care, although this must be following a recent qualified hospital admission. Part A also covers home health care. In both cases, the care must be medically necessary. Medicare won’t cover assistance with activities of daily living, housekeeping or similar services.
Finally, Medicare Part A covers hospice care. This is available for people with a life expectancy of less than 6 months. However, people going into hospice must sign a statement that they’re freely choosing this option. Due to the nature of the condition, most people who need memory care aren’t able to sign this statement.
Which memory care services are covered by Original Medicare Part B?
Once diagnosed, Part B can pay for care planning services to help seniors make decisions about their future. Outpatient prescription drugs for Alzheimer’s disease and dementia may be covered through Part B. If not, they may be covered if a person has a Part D prescription drug plan. It’s important to note that most Medicare plans still require recipients to have the funds for co-pays and deductibles.
Which memory care services are covered by Medicare Advantage?
Medicare Part C, also known as Medicare Advantage, is an insurance option offered by private companies that’s available to seniors instead of Original Medicare. All Medicare Advantage plans must cover the same services covered by Original Medicare, including those listed above. Medicare Advantage plans may also cover additional services, though exactly what’s covered differs widely between plans. Seniors should check their individual plan information to find out what’s covered.
There are also Medicare Advantage plans known as Special Needs Plans (SNPs). These provide benefits tailored to people with specific diseases or conditions. There are SNPs for people with Alzheimer’s disease that provide the coverage needed by people with cognitive decline.