Does Medicare Pay For Memory Care?
September 25, 2023 / Memory Care
Many seniors begin to deal with memory loss as they age, whether from dementia or another condition, and when this memory loss begins to affect their safety in their home, loved ones will begin exploring long-term care options. When doing so, it is likely you will come across a memory care facility, which is designed to provide specialized care for seniors with memory loss. Memory care facilities are safe and secure residential facilities that provide supervision, medication management, assistance with the activities of daily life and even cognitive activities to aid in stimulating the memory. Memory care is a great option for some, but it can be costly. The team at Senior Care AZ, a senior placement agency in Arizona, is breaking down memory care and its relation to Medicare: does Medicare cover it, if your loved one is eligible for Medicare and other payment options for memory care.
What Is Medicare?
Medicare is a government-sponsored health program designed to serve seniors and disabled individuals in the United States. Individuals are eligible for Medicare if they are under 65 and disabled, over 65 and have worked and paid into Medicare throughout their career or they’ve been diagnosed with end-stage renal disease.
Does Medicare Cover Memory Care?
Medicare will not cover the costs of room and board in a memory care facility or assisted living facility, but there are some costs of memory care that will be covered by the program.
Memory Care Services Covered by Medicare
Medicare will cover a number of services provided by memory care facilities, including cognitive assessments to confirm a dementia diagnosis, 100 days of skilled nursing following a major health event such as a hospital stay, care planning to determine treatment options, prescriptions related to memory loss care, and some level of custodial care services.
Memory Care Services Not Covered by Medicare
Medicare is specific about the services that the program will and won’t cover. Medicare will not cover costs associated with room and board in a memory care facility or the costs of long-term memory care. Medicare will also not cover the costs of assistance with the activities of daily life or alternative therapies like herbal medicine or acupuncture.
Additional Memory Care Coverage Options
Original Medicare is the most basic coverage option, and it is Medicare Parts A and B. There are additional plans that individuals may qualify for that could cover the additional costs of memory care.
Medicare Part C (Medicare Advantage Plans)
Medicare Advantage Plans, known as Medicare Part C, are offered through private insurance companies and follow the rules set by Medicare. They include coverage for inpatient care, outpatient care, home health care, health care provider visits, skilled nursing facility care, and hospice care. Similar to private insurance plans, Medicare Advantage plans generally have rules about in-network and out of network providers. Consulting your plan will help determine which services are covered and how you might be able to utilize your Part C to cover the costs of memory care.
Medicare Part D (Prescription Drug Plans)
Medicare Part D is offered through private insurance companies and covers the cost of prescription drugs, including certain shots and vaccines. Part D can be added to an original Medicare plan for a Part C plan that includes drug coverage.
Mediare Special Needs Plans (SNPs)
Special Needs Plans offer insurance for individuals with special needs and function similar to a private insurance PPO or HMO.
Medicare Supplement Insurance (Medigap)
Medicare Supplemental Insurance, or Medigap, helps individuals fill the gaps that their original plan has left in their insurance. Medigap can be purchased from a private insurance company and can help cover things like copayments, coinsurance, and deductibles.
Does Medicare Cover Dementia Care in Home Health Care?
Medicare will cover the costs of part-time home health care for individuals with dementia. Part time care is determined to be care that occurs less than 7 days a week and for less than 8 hours per day. For certain groups, such as Native Americans or Alaska Natives, they may be eligible to receive additional coverage for home health care. In order to receive coverage for home health care, a doctor must determine that the individual is homebound, which means they cannot leave their home without assistance.
Does Medicare Cover Dementia Care in Nursing Homes?
Medicare does not cover the costs of memory care in a nursing home. To receive coverage for the cost of a nursing home, your loved one will need to be eligible and apply for Medicaid, which is based on income instead of age.
Other Ways to Pay For Memory Care
Since Medicare does not cover a large portion of the costs of memory care, many individuals need to come up with alternative payment options to cover the costs of memory care. There are many different options to cover the costs of care, including veterans benefits, long-term care insurance, life insurance, or other private funds. If your loved one is low-income, they might be eligible to receive coverage through Medicaid.