Does Medicare Cover Dementia Care?

• by Christian Worstell
• July 23, 2023
• Reviewed by John Krahnert

Original Medicare (Part A and Part B) and Medicare Advantage (Medicare Part C) plans cover dementia care. How Medicare pays for dementia care can vary depending on the type of facility in which you receive care and the type of care you receive.

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

Some Medicare Advantage plans may also offer additional benefits that Original Medicare doesn't cover. A certain type of Medicare Advantage plan called a Special Needs Plan (SNP) may offer benefits tailored to beneficiaries who have dementia, though these types of plans may not be available in all areas.

When does Medicare pay for dementia care?

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 dementia care 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.

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 $1,600 per benefit period in 2023.

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: $400 coinsurance per day of each benefit period in 2023
• Days 91 and beyond: $800 coinsurance per each “lifetime reserve day” after day 90 for each benefit period in 2023
• 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: $200 coinsurance per day of each benefit period in 2023
• 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 $226 per year in 2023.

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.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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