by Russell Noga | Updated December 28th, 2023
Does Medicare Cover Memory Care?
As the prevalence of Alzheimer’s and dementia continues to rise, understanding the financial implications of memory care becomes increasingly important for families and individuals facing these challenges.
Does Medicare cover memory care services? The answer can be complex, but this comprehensive guide will help you navigate the ins and outs of Medicare coverage, alternative options, and tips for choosing the right memory care facility.
Key Takeaways
- Medicare Part A and B provide coverage for memory care services, but are limited in scope.
- Medicare Advantage Plans and Special Needs Plans offer additional coverage options.
- Medicaid, long-term care insurance, and financial assistance programs may also be available to cover memory care costs. Research is recommended when selecting a facility.
Understanding Medicare’s Coverage of Memory Care
Medicare is a federally funded health insurance plan designed for US citizens and legal residents aged 65 or above or those with a qualifying illness or disability.
While it does provide some coverage for memory care patients, it mainly focuses on medical needs and excludes long-term care and living expenses.
Understanding healthcare coverage options is valuable for Medicare beneficiaries with dementia or Alzheimer’s disease and their loved ones since it aids in determining the most appropriate care management strategy.
For a clearer understanding of Medicare’s coverage of memory care, we will examine its two main parts: Medicare Part A and Medicare Part B.
Medicare Part A and Memory Care
Medicare Part A covers inpatient hospital care, skilled nursing facility care, and hospice care for memory care patients.
However, it does not provide coverage for long-term care or services offered in an assisted living facility. For those eligible, Medicare covers the initial 100 days of care in a nursing home, but after that period, the responsibility of payment falls on the patient and their family.
Medicare Part A also provides coverage for certain expenses associated with hospice care for dementia patients, although the extent of coverage may vary and additional support may be available through state Medicaid services.
Medicare Part A covers a host of services and treatments, including:
- Prescription drugs
- Inpatient facility stays
- Skilled nursing facilities
- Home health care
- Diagnostic tests
- Cognitive assessments for individuals diagnosed with dementia.
Medicare Part B and Memory Care
Medicare Part B focuses on outpatient services, including physician visits, diagnostic tests, and home health care for memory care patients.
It also provides coverage for some mental health services related to dementia and cognitive impairment. Blood tests or brain scans for dementia, as well as doctor visits that include cognitive impairment assessments, are covered under Medicare Part B.
Diagnostic non-laboratory tests covered by Medicare Part B include:
- CT scans
- MRIs
- EKGs
- X-rays
- PET scans for memory loss
Regular doctor visits for memory care patients are also covered, ensuring that those suffering from dementia or Alzheimer’s disease receive consistent care and monitoring.
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The Limitations of Medicare Coverage for Memory Care
While Medicare does offer some coverage for memory care patients, it comes with significant limitations.
Specifically, Medicare cover memory care services does not extend to:
- long-term care
- room and board
- nonmedical assistance with daily living activities
- custodial care or nonmedical care, such as assistance with activities of daily living and rental expenses for medicare cover memory care or other senior care communities.
The main reason for these limitations is that Medicare primarily focuses on medical services and treatments, rather than on long-term or custodial care for dementia patients.
Comprehending these restrictions is significant when planning and budgeting for memory care services.
Medicare Advantage Plans and Memory Care
Medicare Advantage Plans, also known as Part C, offer an alternative to Original Medicare by providing the same standard coverage, including limited coverage for memory care, through private health plans contracted with Medicare.
Some Medicare Advantage plans provide additional coverage for:
- Dental care
- Eye care
- Hearing care
- Prescription drug (Part D) benefits
These additional benefits may help offset some memory care costs.
Special Needs Plans (SNPs) are a type of Medicare Advantage Plan specifically designed for individuals with chronic or disabling conditions, such as Alzheimer’s or dementia.
These plans offer tailored services and coverage to address the unique needs of these patients.
Special Needs Plans (SNPs) for Alzheimer’s and Dementia Patients
SNPs are designed to provide specialized care and services to individuals with specific diseases or characteristics, such as Alzheimer’s or dementia.
These plans offer comprehensive coverage for medical services, prescription drugs, and additional support services like care coordination and care planning services. Disease management programs are also included to ensure a well-rounded approach to the patients’ needs.
Enrolling in an SNP for memory disorders involves the following steps:
- Meet eligibility criteria, such as having a diagnosis of a memory disorder like Alzheimer’s or dementia, and being already enrolled in Original Medicare (Part A and Part B).
- Contact Medicare or the specific SNP directly to inquire about enrollment.
- Complete the enrollment process as directed by the plan.
Alternatives to Medicare for Memory Care Costs
Apart from Medicare, there are other options to help cover memory care costs, including:
- Medicaid: provides coverage for memory care services as part of nursing facility services, with benefits varying by state
- Long-term care insurance: may help cover memory care costs, depending on the specific terms of the insurance policy
- Financial assistance programs: there may be programs available to provide financial assistance for memory care costs
For a clearer understanding of these alternative options for covering memory care costs, we will examine Medicaid and long-term care insurance in more detail.
Medicaid and Memory Care Services
Medicaid, a state and federal program, covers memory care services under nursing facility services, with benefits varying by state.
In all states and Washington, D.C., Medicaid covers nursing home care for individuals with Alzheimer’s or other forms of dementia, but the specific services covered and the manner in which memory care is delivered may differ from state to state.
To learn more about your state’s Medicaid coverage for memory care services, contact your State Medicaid Agency.
Long-Term Care Insurance and Memory Care
Long-term care insurance is a type of insurance policy that provides coverage for expenses associated with long-term care services, including nursing home care and home care services.
Eligibility for long-term care insurance typically requires a reoccurring need for skilled nursing care that has been medically predicted, and an inability to perform at least two of the six ‘activities of daily living’ (ADLs).
The extent of coverage for memory care costs provided by long-term care insurance depends on the specific terms of the insurance policy, so reviewing your policy to understand what memory care services are covered is advised.
Keep in mind that Medicare and most types of health insurance plans generally do not cover the costs of long-term care services, including memory care.
Finding Memory Care Facilities that Accept Medicare
To find memory care facilities that accept Medicare, follow these steps:
Go to the Medicare website at www.medicare.gov.- Select the ‘Find & Compare’ tab in the top navigation menu.
- Choose the ‘Memory Care Facilities’ option.
- Enter the desired location.
- Refine your search using filters such as star ratings, number of beds, and staff turnover.
- Compare the facilities based on their ratings and other factors.
- Click on individual facilities to obtain more detailed information about their services and contact information.
Another helpful approach for finding Medicare-approved memory care facilities is to consult with care planning teams, such as Alzheimer’s associations or healthcare professionals with dementia expertise.
These teams can offer guidance and recommendations based on their experience and knowledge of memory care facilities that accept Medicare coverage.
Navigating Financial Assistance Programs for Memory Care
BenefitCheckUp.org is an extensive online resource that connects elderly individuals and those with disabilities to benefits. It can help you find financial assistance programs for memory care services, including Medicare, SSDI, and SSI.
To access BenefitCheckUp.org, visit the website at benefitscheckup.org and explore the comprehensive information on federal and state government programs that may provide financial support for memory care services.
Other websites similar to BenefitsCheckUp.org that provide assistance with financial aid for memory care include Debt.org, Alzheimer’s Association, and BrightFocus Foundation.
These resources can help you navigate the complex landscape of financial assistance programs and potentially alleviate some of the financial burden associated with memory care services.
Tips for Choosing the Right Memory Care Facility
When selecting the right memory care facility, factors such as specialized staff training, therapy options, facility design, and acceptance of Medicare or Medicaid coverage should be taken into consideration.
Specialized staff training ensures that caregivers are equipped with the knowledge and skills necessary to provide appropriate care and support for individuals with dementia or Alzheimer’s.
Therapy options, such as habilitation therapy, occupational therapy, and physical therapy, can address the needs and challenges associated with memory loss and promote overall well-being.
Also, the design of the memory care facility plays a significant role in providing a safe and comforting environment for residents.
Look for facilities that incorporate features such as locked doors and keypads to ensure safety, as well as distinctive artwork and dining spaces that promote a sense of familiarity and ease.
Lastly, consider whether the facility accepts Medicare or Medicaid coverage, as this can significantly impact the affordability of memory care services.
Summary
In conclusion, navigating the world of memory care services and understanding Medicare coverage can be a complex task.
While Medicare provides limited coverage for memory care services, it’s essential to explore alternative options such as Medicaid, long-term care insurance, and financial assistance programs to help cover the costs.
By using resources like Medicare’s Find & Compare tool and consulting with care planning teams, you can make informed decisions and find the right memory care facility for your loved one.
Remember, knowledge is power, and understanding your options can help you make the best choice for yourself and your family.
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Frequently Asked Questions
Does Medicare take care of dementia patients?
Yes, Medicare provides coverage for dementia patients, such as home health care for those certified as “homebound”, end-of-life hospice care, inpatient hospital care, and up to 100 days of skilled nursing home care. Additionally, Medicare Part D covers many prescription drugs.
What is the difference between memory care and dementia care?
Memory care is geared towards those who require assistance with everyday tasks, but are still capable of functioning independently. Conversely, dementia care is designed for individuals with advanced neurodegeneration that struggle to perform basic tasks.
Is dementia considered a disability for Medicare?
Yes, dementia is considered a disability for Medicare since patients with Alzheimer’s or other forms of dementia can qualify for neurocognitive disorders benefits with medical evidence showing their decline in memory, learning, judgment, and planning skills.
What benefits is a person with dementia entitled to?
People with dementia may be eligible for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI), as well as Medicaid, veteran benefits and other tax deductions and credits.
Additionally, Medicare will pay for up to 35 hours a week of home health care for people who meet the criteria for “homebound”, while Medicaid covers in-home care if nursing home care would otherwise be required.
Does Medicare cover memory care services?
Yes, Medicare provides limited coverage for memory care services, focusing mainly on medical needs. However, it does not cover long-term care or living expenses.
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Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.