Medicaid, Medical, and Medicare: these government-funded programs all help people cover the costs of dementia care. But is memory care covered under Medicare?
At Village Walk, our senior care concierge team answers this question more than you know. The short answer is yes — but only somewhat.
Nothing’s worse than paying for medical services you’re not completely familiar with, which is why we’re here to shed light on the role of Medicare with memory care.
If you’re looking for answers about whether Medicare covers the cost of memory care, you’ve come to the right place.
In this article we’ll discuss the following:
- What’s covered (and not covered) by Medicare for memory care services for seniors
- Different types of Medicare plans as they relate to memory care
- Payment options for covering the costs of memory care
- How to enroll in and pay for a Medicare plan
- FAQ about Medicare and memory care
What’s covered (and not covered) by Medicare
| Services covered by Medicare | Services not covered by Medicare |
| 1. Cognitive assessments to confirm a diagnosis of dementia 2. Up to 100 days of skilled nursing care following an event like a hospital stay 3. Planning for continued care and counseling 4. Prescription medication for dementia 5. Other custodial services depending on the case or situation | 1. Room and board, and rent, associated with memory care or assisted living 2. Long-term memory care Long-term help with activities of daily living (ADLs) 3. Non-western-style therapies like acupuncture or herbal medicine |
Making sense of Medicare and memory care
Medicare sounds like Medicaid, but the two programs are very different. Let’s make sure we have our definitions straight.
Americans age 65 and older — and some younger people who live with a qualifying disability or health condition — are eligible for Medicare.
Medicare is a federally funded health insurance program that covers a wide range of services, including inpatient hospital care, outpatient doctor visits, and more.
Medicaid is a public health insurance program administered by each individual state. The goal of Medicaid is to help reduce barriers to care for low-income people of all ages.
Finally, memory care is a type of residential long-term care service for people with Alzheimer’s and forms of dementia. In memory care neighborhoods, in-house caregivers provide services to keep residents safe and supported.
Continuing care communities — like assisted living and memory care neighborhoods — provide a smooth transition from one community into the next. For older adults who need a higher level of support, the senior care staff at continuing care communities can transition older adults from assisted living to memory care with ease.
Skilled nursing facilities, stand-alone memory care centers, adult day services, and board and care homes: these facilities all provide memory care support to those living with dementia.
What’s more, a person can receive memory care services within the comfort of their home. But, in-home and facility-based memory care is different from assisted living and independent living. With the latter, any older adult can apply and sign up.
A person is only eligible for memory care if they’ve been assigned an Alzheimer’s or dementia diagnosis by a medical professional.
Did you know?
Did you know that our community often holds informational seminars about the A, B, C, and D’s of Medicare? Check us out on social media for more details.
Medicare coverage for memory care expenses
“Medicare may cover some memory care expenses, right?” You might wonder. Yes, that’s right.
If someone with dementia is 65 years or older and enrolled in Medicare, Medicare may cover some of the health care related to dementia care and long-term nursing home care.
The three main forms of Medicare that can cover memory care expenses include:
- Original Medicare (Part A and Part B)
- Medicare Advantage (Medicare Part C)
- Medicare Supplement (Medigap)
We’ll detail how each can cover memory care costs in the following sections.
Original Medicare provides limited coverage for memory care
With original Medicare — often called Medicare Part A and Part B — original Medicare won’t pay for rent or other living costs associated with staying in memory care units. However, Medicare Part A and Part B may cover services that a person with Alzheimer’s or dementia would need as part of a hospital or inpatient stay.
Coverage under Part A, which covers inpatient hospital care and skilled nursing facility care, includes:
- Up to 100 days in a skilled nursing facility after a hospital admission: including nursing home care that’s medically necessary and unrelated to daily activities such as eating, dressing, and using the restroom.
- Home health care: for those who are homebound due to a qualifying condition. Coverage for home health care doesn’t include help with activities of daily living like dressing, bathing, housekeeping, or using the restroom.
- Hospice care: for individuals with a life expectancy of six months or less. To qualify for hospice with Medicare, care recipients must choose this option of their own volition. Because a person with dementia or Alzheimer’s isn’t always able to make end-of-life decisions with as sound of mind as a person without dementia or Alzheimer’s, hospice care is often an option for those seniors who’ve created advance directives or assigned a health care proxy before being diagnosed with dementia.
Coverage under Part B, which covers medical preventive services for routine healthcare conditions, includes:
- Cognitive testing and evaluations: during an annual Medicare wellness visit or visits with specialists looking for signs of cognitive impairment.
- Care planning services: care planning allows individuals with dementia, their caregivers, and their families to understand which care services, treatment options, and support are available for dementia and memory care conditions.
- Outpatient prescription medication for Alzheimer’s and other forms of dementia: the only caveat here is that Medicare states that prescribing physicians must log their patients’ information into a registry called the Prescription Drug Monitoring Program (PDMP) to be eligible to receive prescription medication coverage. What’s more, patients are responsible for copays after meeting their Medicare Part B plan’s deductible.
Medicare Advantage (Medicare Part C) and memory care costs
Also known as Medicare Part C, Medicare Advantage includes private health plans that contract with Medicare to offer the same services that Medicare Part A and Part B offer.
“Why not choose Part A and Part B coverage instead?” you might be wondering.
Well, many different Medicare Advantage plans exist. Some plans offer more coverage for popular healthcare services like dental, vision, and hearing care.
Other Medicare Part C plans offer prescription drug benefits through Medicare Part D, the Medicare program responsible for providing prescription drug coverage.
Medicare Supplement (Medigap) and memory care costs
Medigap is optional. This coverage plan is purchased through private insurers.
Medigap bridges the gap between what Medicare Parts A and B cover and what those services cost out-of-pocket, that is, any deductibles, copays, and coinsurances owed by the insured.
Similar to Medicare Part A and Part B, Medigap won’t cover most long-term memory care costs. They will, however, pay for the services that Medicare Part A and Part B offer.
Understanding payment options for memory care
We’ve covered Medicare Part A, Part B, Part C, Part D (briefly), and Medigap. Now, does memory care cost the same throughout the U.S.?
As you guessed it, costs depend on the geographical region and type of facility providing memory care. For example, memory care in states in New England and along the Western end of the United States, like New York, Massachusetts, California, and Hawaii, tends to cost more than in southern states like Alabama and Georgia (Statista, 2024).
Since Medicare doesn’t cover the cost of room and board, seniors and their loved ones should do their research to discover how to pay for dementia care room and board costs.
Fortunately, financial assistance for memory care is available. People often use financial assets, long-term insurance, personal savings, and other benefits to cover care services provided in a memory care facility.
Let’s take a look at some of the ways people pay for memory care.
Ways to pay for memory care
Memory care is expensive — there’s no doubt about that. Here are a few ways to help cover the costs of memory care, including:
- Medicaid: Medicaid will cover 100% of the costs of a nursing home stay, but will not cover the cost of room and board in assisted living or dedicated memory care facilities. With that being said, Medicaid will pay for some memory care services if those services are administered in a Medicaid-approved facility.
- Veterans benefits: Veteran Affairs (VA) programs also provide coverage for eligible veterans with Alzheimer’s and other forms of dementia. The VA will cover long-term inpatient and outpatient custodial care, adult day health services, caregiver support, and other services for qualifying eligible veterans.
- Long-term care insurance: many long-term care insurance providers reimburse for the costs of memory care, but insured individuals may have to wait to receive care. Make sure to research what’s included in each policy, as well as any limitations that exist, before signing up for long-term care insurance.
- Reverse mortgages: with a reverse mortgage, you can take home equity and use it to pay for long-term care. With that being said, personal care is limited to in-home care. Penalties exist if a homeowner uses cash from a reverse mortgage to cover the costs of care living in a care facility for a year or more.
- Private assets: One of the most common ways of covering the cost of memory care is through private assets. Personal savings, Social Security income, pension payments, 401(k) accounts, and family-funded support can help pay for the cost of expenses in a care facility.
How to enroll in and pay for a Medicare plan
While Medicare won’t cover the entire cost of memory care services, it does cover key health care services used in memory care.
You can check online free tools, like BenefitsCheckUp.org or Medicare’s “Helpful Tools” website page, for financial assistance programs, educational resources, and other key information needed to pay for memory care.
Village Walk: senior care specialist offering help with all things memory care
Medicare enables those with an official Alzheimer’s or dementia diagnosis to be eligible for limited memory care coverage. Although average costs vary by state, long-term care options and Medicare are available to qualifying individuals.
Speaking of Medicare, navigating the fine print of Parts A, B, C, and D of Medicare can be challenging.
But plenty of seniors have found success in finding the right Medicare coverage for their memory care needs.
Here at Village Walk, we’ve seen how with the right help, seniors can find the right Medicare coverage for their memory care-related needs.
If you’re looking for helpful information from friendly professionals about Medicare coverage and memory care, look no further. Contact one of our expert senior care specialists today on how Medicare can help your loved one.
FAQ about Medicare coverage for memory care
1. How do Medicare and Medicaid cover memory care costs?
Medicaid and Medicare differ in the way they’re able to support individuals in covering memory care costs. As mentioned earlier, people can use Medicare to pay for some memory care costs, but coverage is somewhat limited.
Medicaid will pay 100% of the costs of a nursing home stay, including memory care services provided within the scope of said nursing home care. With that being said, people using Medicaid won’t be able to cover the cost of rent in an assisted living neighborhood.
The good news is that Medicaid can pay for some memory care services to eligible patients, so long as those services are delivered in a Medicaid-approved facility.
2. What are Special Needs Plans with Medicare?
Special Needs Plans (SNP) are types of Medicare Advantage plans that are limited to people with chronic conditions.
Medicare special needs plans include:
- Chronic condition SNPs (C-SNP): these plans are for people who have chronic conditions that are life-threatening or disabling. Conditions such as chronic alcohol and drug dependence, neurologic disorders, cardiovascular disorders, cancer, HIV/AIDS, and other disorders are included
- Dual-eligible SNPs (D-SNP): these plans are for people eligible for both Medicare and Medicaid.
- Institutional SNPs (I-SNP): these plans are for people residing in long-term care settings.
3. Where can I contact a Medicare professional for more information?
You can phone Medicare’s dedicated phone hotline at 1-800-MEDICARE (800-633-4227). For users using teletypewriters (TYY) or telecommunications devices for the deaf (TDD), contact (877) 486-2048.
Alternatively, if you wish to speak with a friendly concierge staff member, you can contact the senior care advisors at Village Walk.
For questions about memory care coverage and Medicare, don’t hesitate to reach out to us at (631) 503-9000 or villagewalkseniorlivinglife@villagewalkseniorliving.com.
