Does Medicare Cover Assisted Living For Dementia? [2022 Update]
Many families wonder if Medicare will pay for their loved one’s assisted living costs.
After all, it can be a full-time commitment to care for people with dementia, and most individuals cannot afford to do this.
Let’s dive into the details of whether Medicare will cover assisted living for dementia.
Before delving into this subject, let’s first take a quick look at what Medicare entails. Medicare is a federal health insurance program established for people 65 years of age or older and with specific disabilities.
The Five Components of Medicare
There are various parts to Medicare:
- Medicare Part A: covers inpatient hospital care
- Medicare Part B: covers outpatient care (e.g., doctor visits)
- Medicare Part C (Medicare Advantage): an alternate way to get Medicare Parts A & B benefits. These plans typically bundle also include additional coverage, such as dental, vision, hearing, and even wellness care
- Medicare Part D: covers prescription drugs
- Medicare Supplement Insurance (Medigap): helps pay Original Medicare out-of-pocket costs (it does not cover additional services)
As the above descriptions indicate:
Dementia care will come from either Original Medicare benefits or bundled Medicare Advantage benefits
Dementia Care 101
Dementia is a decline in mental ability, including memory loss and difficulties with language, thinking, judgment, and behavior.
The most common type is Alzheimer’s disease, but there are also other types of dementia, including vascular dementia and frontotemporal lobar degeneration.
What Are The Symptoms of Dementia?
Here are some signs of dementia (although not all individuals will experience every symptom listed):
- Trouble remembering things that happened recently or familiar names
- Changes in mood or behavior (e.g., aggressiveness, agitation, delusions, hoarding)
- Trouble completing daily tasks (e.g., bathing, dressing)
- Confusion (e.g., losing track of time or place)
Dementia Care Options
There are two basic options for dementia care: in-home care or care at a facility.
Skilled Nursing vs. Assisted Living Facilities
Skilled nursing facilities are medical facilities that provide health services to patients who are typically recovering from an illness or injury. These facilities also provide additional care for chronic and/or degenerative conditions such as dementia and Alzheimer’s disease.
This type of long-term care is a good option if your loved one needs additional services or extensive medical care not provided by assisted living facilities. These facilities typically provide 24-hour supervision and assistance, so you can rest assured that your loved one is in good hands.
Many people assume that assisted living provides the same type of around-the-clock supervision, but it doesn’t always work out this way. While they provide similar services, there is a crucial distinction:
Skilled nursing facilities provide personal care AND medical care. Assisted living facilities focus on the daily living and social needs of the resident.
Assisted living facilities are designed for seniors who need help with daily activities, including eating, dressing, bathing, and walking.
Does Medicare Cover Dementia Care?
Does Medicare cover assisted living for dementia? We won’t beat around the bush:
Your Medicare benefits will not be of much help when it comes to dementia care (also known as “memory care”).
Skilled Nursing Home Care
Medicare will pay for 100% of the cost of care up to 20 days at a skilled nursing facility and approximately 80% of the cost up to 80 more days.
The care must be for recovery following an inpatient hospital stay.
These days of skilled nursing care renew at the beginning of every benefit period.
Assisted Living Facilities
Medicare does not cover any cost of assisted living. It will pay for most medical costs incurred while the person with dementia is in an assisted living facility. Still, it will pay nothing toward custodial care (personal care services) or an assisted living facility’s room and board cost.
Medicare will cover skilled nursing care in the home for a limited time period, but not non-medical care. Care must be prescribed by a doctor and needed part-time only.
The senior must be “confined,” meaning they cannot leave the home without the assistance of another person. This is informally referred to as “homebound. ”
Will A Medicare Advantage Plan Cover Dementia Care?
Some Medicare Advantage plans may pay for personal care assistance for persons residing in assisted living or memory care but will not contribute towards the cost of room and board.
However, non-medical, in-home personal care assistance and adult daycare services may be available through some Medicare Advantage plans.
The Overall Picture
Unfortunately, most care associated with Alzheimer’s is considered custodial or personal care, and therefore, not paid for by Medicare. That said, some Medicare Advantage plans may cover the cost of personal care assistance.
For very late-stage Alzheimer’s patients, a hospice care benefit may apply to Medicare beneficiaries.
Frequently Asked Questions
Medicare offers coverage for diagnosing dementia, but does not cover treatment. If you have Medicare, you are covered for a limited number of doctor visits every year to diagnose the problem, but after that point, there is no more coverage offered. This can be expensive if you have very frequent symptomatic episodes of dementia involving hospitalization or your normal doctor’s office visits are without insurance, so it would be wise to talk with some medical professionals about what other types of coverage might work for you.
Medicare covers medically necessary services for dementia patients, but it does not cover custodial or personal care or the costs of living in a memory care facility. Inpatient hospital stays, skilled nursing care up ond 100 days, and hospice are all covered under Medicare coverage for someone with dementia.
Medicare will pay for 100% of the cost of care up to 20 days at a skilled nursing facility and around 80% of the expense for Days 21-100. This SNF care must follow an inpatient hospital stay. Medicare does NOT cover assisted living expenses.
Conclusion & Key Takeaways
Does Medicare pay for assisted living facilities or non-medical personal care services? The answer is an unequivocal no. However, if you’re struggling with care for your loved one who has dementia, there is good news:
- Medicare pays for skilled nursing care at home for a limited time period if it follows an inpatient hospital stay.
- Medicare covers most medical costs incurred while in an assisted living facility.
- Also, some Medicare Advantage plans (called Special Needs Plans) are structured with dementia care in mind.
We hope you found this article on Medicare’s coverage of dementia care helpful. If you have any additional questions, don’t hesitate to leave a comment or send us an email, and we will get back to you within 24 hours.
The GetSure Team