Does Medicare cover dementia?

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Guest post by Danielle Roberts

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Medicare is a federal health insurance program that covers people aged 65 and older and people with certain disabilities. It has several parts that provide inpatient care, outpatient care, and prescription medications.

In general, Medicare will cover any care that is deemed medically necessary by a doctor who is contracted with Medicare. Part A provides for inpatient hospital stays, short-term skilled nursing facility care, and hospice care. Part B covers preventive care, doctor visits, lab-work, diagnostic imaging, durable medical equipment, ambulance, emergency, cancer treatments, dialysis and more. 

While Medicare covers the bulk of the costs of your care, you are responsible for Part A and B deductibles, coinsurance and copays. Medigap plans can be purchased to help you pay for these items.

Medicare beneficiaries also have the option to purchase a Part D drug plan, which will help to pay for the cost of retail outpatient drugs. Most formularies cover important medications related to dementia treatment.

Something Medicare does not cover is custodial care or long-term care. If a patient enters a skilled nursing facility after a hospital stay, Medicare will only pay for up to 100 days of care. This care is designed to be rehabilitative, with the goal being to return the patient to independent living after the care.

If a patient with a dementia is in decline and not expected to recover and assume the regular activities of daily living, then that patient would need to move into long-term care, which is not covered by Medicare. Beneficiaries can private pay for their care, or if their assets and income is below a certain level, they can qualify for Medicaid to help pay for this care. Visit with your local elder law attorney to learn more. 

Danielle K. Roberts is the co-founder of Boomer Benefits, where her team helps seniors navigate Medicare plan options.

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Rachael Wonderlin is an internationally-recognized dementia care expert and consultant. She has a Master’s in Gerontology and is the author of three published books with Johns Hopkins University Press. Rachael owns Dementia By Day, a dementia care consulting and education company.

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