Does Medicare Cover Dementia Care?

Medicare typically does cover some costs related to dementia care. The part of Original Medicare (Part A and Part B) that covers your dementia care will depend on the type of facility in which you receive care.

Medicare Advantage (Part C) plans can also cover dementia care.

Some Medicare Advantage plans may also offer additional benefits that can help with dementia care, such as home modifications, adult day care and non-medical care at home, all of which are not typically covered by Original Medicare.

Plan benefits may vary and may not be available in all locations.

Call to speak with a licensed insurance agent who can help you determine your eligibility to enroll and find Medicare Advantage plans in your area that offer dementia care benefits at 1-800-557-6059 1-800-557-6059 TTY Users: 711, 24/7.

Does dementia qualify for Medicare coverage?

Original Medicare may cover some but not all costs related to dementia care.

Medicare Part A hospital insurance will typically cover some of the following costs:

• Inpatient hospital care related to dementia or Alzheimer’s care
  
  
• Up to 100 days of skilled nursing facility (SNF) care under certain circumstances
  
  
• Hospice care in the home, nursing facility or inpatient hospice facility for end of life care

Medicare Part B may cover other services related to dementia care, such as:

• Annual cognitive assessment as part of your Medicare Annual Wellness Visit
  
  
• Care planning services for individuals diagnosed with dementia
  
  
• Any additional diagnostic testing that is ordered by your doctor
  
  
• Occupational therapy that is ordered by your doctor to help improve cognitive function

Speak with your doctor directly for more Medicare coverage information related to your dementia or Alzheimer’s care.

Medicare Advantage plans may offer more benefits for dementia care

As part of the Chronic Care Act of 2018, Medicare Advantage plan providers are able to provide expanded benefits to their beneficiaries, called “supplemental benefits,” starting in 2019 and 2020.

Some of these additional benefits may include:

• Home modifications, such as bathroom grab bars
  
  
• Non-medical home care, such as custodial care (help with using the bathroom, eating, dressing or exercising)
  
  
• Adult day care

Because Medicare Advantage plans are sold by private insurance companies, plan availability and the benefits they offer may vary from one location to another.

To learn more about Medicare Advantage plans in your area, your eligibility to enroll, and the benefits that they offer, call to speak with a licensed insurance agent today.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

How much does dementia care cost with Medicare?

Depending on the type of dementia care you receive, you may be responsible for different types of Medicare costs, such as:

• Part A deductible
• Part A coinsurance
• Part B deductible
• Part B coinsurance or copayment

Medicare Part A deductible for inpatient services and hospice care

You must meet the Part A deductible before your Part A coverage kicks in for inpatient care related to dementia.

The Medicare Part A deductible is $1,364 per benefit period in 2019.

The Part A deductible is not annual, and you could experience more than one benefit period in a calendar year. A benefit period starts the day you are admitted for inpatient care and ends when you have not received inpatient care for 60 consecutive days.

If Part A covers hospice care related to your dementia or Alzheimer’s disease, you pay nothing for your hospice care, including the Part A deductible.

You may need to pay a 5 percent coinsurance for the Medicare-approved amount for inpatient respite care, as well as a $5 copayment for your prescription drugs while receiving hospice care.

Medicare Part A coinsurance

If you experience an inpatient hospital stay related to your dementia care, you will typically be responsible for the following coinsurance costs after meeting your deductible:

• Days 1-60 spent in the hospital: $0 coinsurance for each benefit period
• Days 61-90: $341 coinsurance per day of each benefit period in 2019
• Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period in 2019
• Beyond lifetime reserve days: you pay all costs

 You cannot accrue any additional lifetime reserve days.

If you are admitted to a skilled nursing facility for care, you will be responsible for the following coinsurance costs:

• Days 1-20: $0 coinsurance for each benefit period
• Days 21-100: $170.50 coinsurance per day of each benefit period in 2019
• Days 101 and beyond: you pay all costs

Medicare Part B deductible

You must meet your Part B deductible before your Part B coverage for things like occupational therapy and doctor’s office visits kicks in.

The Medicare Part B deductible is $185 per year in 2019.

Medicare Part B coinsurance or copayment

After you meet the Part B deductible, you typically pay 20 percent of the Medicare-approved amount for most doctor’s services.

There is no annual limit on how much you could pay for the Part B coinsurance in a given year.

Medicare Advantage Special Needs Plans (SNP) for Alzheimer’s Disease

Special Needs Plans are a type of Medicare Advantage plan that can offer specialized care and coverage specifically limited to patients with a certain condition or situation, such as dementia or Alzheimer’s disease.

Medicare SNPs are not available in all locations. If an SNP is available near you, you may be able to enroll and enjoy benefits such as:

• Providers who specialize in treating dementia
• A care coordinator who helps manage all of your health care services, medications, diet and more
• Additional prescription drug coverage for specific drugs that help treat your dementia

Learn more about the Medicare SNPs that may be available in your area and if you meet the eligibility criteria. If none are available, you may be able to find another type of Medicare Advantage plan that fits your coverage needs.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.