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Will Medicare Pay for a Person with Dementia? 

February 16, 2024

People experiencing dementia are deserving of the utmost respect and care. We all know this, and yet, with a world of care options and resources available, it can be difficult to decide what is best for you and your loved one experiencing memory loss, especially when cost is a factor. 

Will Medicare pay for a person with dementia? Follow along as we cover different options for memory care, as well as, importantly, how much Medicare, Medicaid, and long-term insurance will cover these crucial services in your state.

What Is the Difference Between Memory Care and Dementia Care?

Before diving into how to pay for memory care, let’s discuss the difference between memory care and dementia care. Memory care is specialized support for anyone experiencing memory deterioration, so often, patients with Alzheimer’s, dementia, amnesia, or other memory loss conditions will be cared for in these facilities. As an individual’s memory deterioration progresses and they show more difficulty engaging in their essential daily tasks, it may make sense for them to have more advanced care, which is what dementia care is meant for. 

Does Long-Term Care Insurance Cover Memory Care?

Long-term care insurance is designed to cover long-term support services like assisted living and will often help cover the costs of memory care. However, the extent of your loved one’s dementia insurance coverage will depend on the terms of their specific policy, including things like the type of care that can be covered, the dollar amount limit on benefits, and other conditions. 

Will Medicare Pay for a Person with Dementia?

Medicare, the federal health insurance program for people 65 and older, covers many different medical services. When it comes to paying for dementia patients, however, Medicare will cover some but not all costs of care in memory care and dementia care facilities. For example, it will cover part-time home health care costs for dementia and up to 100 days in a skilled nursing facility, but not long-term care or the assistance with activities of daily living (ADLs) that many dementia patients need. Because Medicare only covers “medically necessary care,” usually reserved for things like skilled nursing care, hospital stays, outpatient care, etc., families often must turn to other options for financial coverage.

Does Medicare Pay for Hospice Care for Dementia?

Hospice care is considered medically necessary care, and thus, Medicare will cover end-of-life hospice care for dementia patients and others experiencing memory deterioration as long as a doctor has certified that an individual has a life expectancy of six months or less. Palliative care, which helps relieve pain and other symptoms for patients, is also completely covered by Medicare when in hospice.

Does Medicare Pay for In-Home Health Care for Dementia Patients?

When it comes to dementia, Medicare can cover certain aspects of in-home health care, but it’s important to understand the specifics.

In-Home Health Care Services

For individuals with dementia, in-home health care services can be a critical component of their overall care plan. Medicare may cover in-home health care under the following conditions:

  • Skilled Nursing Care: If a medical professional determines that a dementia patient requires skilled nursing care (like wound care or physical therapy), Medicare Part A may cover it, but usually only for a limited period.
  • Therapy Services: Physical, speech, and occupational therapy services may be covered when they are ordered by a doctor and provided by a Medicare-certified home health agency.
  • Medical Social Services: Medicare may cover services like counseling or help in finding resources in your community to help manage dementia.
  • Part-time or Intermittent Home Health Aide Services: This can include help with activities like bathing and dressing, provided it is part of the home health care for your illness or injury.

Limitations and Considerations

It’s crucial to note that Medicare does not cover 24-hour-a-day care at home, meals delivered to your home, or homemaker services (like shopping, cleaning, and laundry) when these are the only care needed. Also, the coverage is typically for short-term services aimed at improving health conditions.

Navigating the Path Forward

Caring for someone with dementia is a path filled with challenges and emotional moments. While Medicare can provide support for certain in-home health care services, each situation is unique. It’s essential to consult with healthcare professionals and a Medicare expert to understand the specific coverage available for your circumstances.

Remember, you are not alone on this journey. There are numerous resources and communities available to support you and your loved one living with dementia. Embracing both the challenges and the moments of joy along this journey can make a significant difference in the quality of life for both you and your loved one.

How Long Does Medicare Pay for Nursing Home Care?

Except for some rare and specific conditions, Medicare does not cover nursing home care. However, if it is determined that a patient requires skilled nursing services, like if they’re recovering from a surgery or stroke, Medicare will pay for a nursing home stay for up to 100 days. After that, a nursing home stay can be paid for with an individual’s personal resources, Medicaid (if applicable for your state), or a combination of the two.

Does Medicare Pay for Memory Care in Florida?

Medicare typically does not cover the cost of memory care in Florida. It will still cover things like doctor visits and medications, as we’ve mentioned, but will not cover the costs incurred by staying at a memory care facility. Florida Medicaid, however, will pay up to $1,500 a month towards the cost of assisted living or memory care. 

Does Medicaid Cover Memory Care In Indiana?

Unfortunately, Indiana’s Medicaid program, like most in the U.S., does not cover memory care. However, there are certain waivers that the state offers (such as the Aging & Disabled Waiver) that can provide a path to Medicaid funding, depending on the residency, facility qualification, family income, and the individual’s memory care requirements.

Does Medicare Take Care of Dementia Patients?

Ultimately, Medicare offers options for dementia patients and those experiencing memory loss, but is not the end-all-be-all of covering memory care and dementia care services. Medicare will pay for some services during each stage of dementia care, including cognitive assessments, home safety evaluations, hospital stays, and prescription drugs. However, families will often have to explore options beyond Medicare in order to fully cover care.

How Story Cottage Can Help

Memory care and the many considerations that go along with it can be difficult for dementia patients and the family members of those loved ones to grapple with. Story Cottage is here for you during this difficult time to answer questions, provide resources, and care for your loved one. If you are ready to learn more about the calm environment that Story Cottage can provide your loved one, contact us to schedule a visit at our two beautiful locations in Indianapolis and Carmel.