Does Medicare cover memory care and dementia care?

How many people have dementia?

Dementia is fairly common among older adults. According to a Columbia University study, nearly 10% of people age 65 or older in the U.S. have dementia, and an additional 22% have mild cognitive impairment.²

Alzheimer’s disease is the most common cause of dementia, but there are numerous other causes of dementia, including cerebrovascular disease, Lewy body disease, frontotemporal degeneration, and Parkinson’s disease.³

Does Medicare cover PET scans and other diagnostic assessments for dementia?

Yes. Medicare Part B covers a range of testing and imaging for diagnosing dementia.⁴

In the past, Medicare coverage of amyloid PET (Positron Emission Tomography) scans for diagnosing dementia was limited to once per lifetime, and only if the patient was enrolled in a clinical trial. However, CMS removed those coverage restrictions in October 2023. ⁵

There is no longer a lifetime limit of one covered amyloid PET scan or a requirement that the patient be part of a clinical trial. Instead, coverage determinations are now left to regional Medicare Administrative Contractors (MACs).⁵ CMS noted that MACs “use an evidence-based process for making coverage determinations” and the agency “believe(s) there will be consistent coverage across regions for appropriate Medicare patients.”

The Alzheimer’s Association applauded the CMS decision on amyloid PET scan coverage, noting that “a valuable Alzheimer’s disease diagnostic tool will now be more accessible across the country” as a result of the rule change.⁶

Does Medicare pay for assisted living for dementia patients?

No. Medicare does not pay for assisted living or any form of custodial long-term care.¹

If a dementia patient has an inpatient hospital stay and subsequently needs skilled nursing care before being able to return home, Medicare will cover up to 100 days in a skilled nursing facility if the beneficiary needs skilled nursing care, as opposed to just assistance with activities of daily living.⁷

Although Medicare does not cover custodial long-term care, Medicaid does cover some types of long-term care and is the primary payer of long-term care services in the United States.⁸ But it’s important to understand that assisted living is not the same as nursing home care from the perspective of Medicaid coverage. (Note that nursing home care and SNF care are also not the same thing, although they can be provided in the same facility. In general, a nursing home provides a permanent home for a person who needs round-the-clock care – including custodial care – whereas SNF care is temporary and aimed at helping a person recover from an illness or injury.)

Although Medicaid will cover nursing home costs nationwide,⁹ Medicaid coverage of assisted living facility costs is not always available, and the specifics vary from state to state. Most states have Home and Community-Based Services (HCBS) waivers that can be utilized by Medicaid enrollees to help pay for the cost of assisted living. But the specifics of these waiver programs are different in each state, and they also tend to have waiting lists to receive services.¹⁰

Read more from Medicare.gov about other possible solutions for long-term care needs.

Does Medicare pay for memory care facilities?

No. Medicare does not pay for the non-medical costs associated with a memory care facility, including room and board and assistance with activities of daily living.¹

Medicare will, however, continue to cover the cost of medical care (as opposed to custodial care) received by a beneficiary living in a memory care facility.

Medicaid coverage of memory care falls under HCBS waivers, so it’s similar to the coverage described above for assisted living. This means Medicaid memory care benefits and coverage availability differ by state.¹¹

Does Medicare cover home healthcare for dementia patients?

Whether Medicare covers home healthcare for dementia patients depends on the reason why home healthcare is needed.

Medicare Part A will pay for up to 35 hours of in-home care per week for a beneficiary who is “homebound” and in need of part-time skilled nursing care.¹²

Home health aide care (help with activities of daily living such as bathing and dressing) can be covered as part of Medicare’s home health care benefit if the patient is receiving skilled care at the same time (skilled nursing care or occupational, physical, or speech therapy). But Medicare’s home health care benefit cannot be used to provide only assistance with activities of daily living, without concurrent skilled care also being provided.¹³

The Medicare-Medicaid Program of All-Inclusive Care for the Elderly (PACE) is an option for some older adults. Availability, benefits, and enrollment caps under PACE vary by state, but PACE may  provide home care benefits.¹⁴

To qualify for PACE, an applicant must need a nursing home level of care but be able to live safely in the community with the assistance provided by PACE. Most PACE enrollees are dually eligible for both Medicare and Medicaid.¹⁵

Does Medicare cover adult day care?

No. Medicare does not cover the cost of adult day care.¹⁶

Medicaid waivers, including HCBS waivers, may allow a state to provide Medicaid coverage for adult day care. As is the case for any waiver-based programs, the benefits and availability differ from one state to another.¹⁷

PACE, described above, may also provide adult day care benefits, although the specifics vary by state.¹⁸

Is dementia medication covered by Medicare?

Yes. Medications approved by the FDA to treat dementia and cognitive impairment may be covered by Medicare Part D if they’re self-administered, or by Medicare Part B if they’re administered via infusion in a medical office.

Current drug treatments cannot cure dementia, but they can help slow its progression or temporarily alleviate some of the symptoms. If a medication is recommended, the specifics will depend on the stage and type of dementia. (For example, some commonly used medications are not recommended for frontotemporal dementia.)¹⁹

The available drugs include cholinesterase inhibitors (donepezil, rivastigmine, and galantamine)²⁰ and N-Methyl-D-aspartate (NMDA) receptor antagonists (memantine),²¹ as well as anti-amyloid therapies (Leqembi and Aduhelm) for Alzheimer’s dementia.²²

In addition, physicians can prescribe a variety of medications to alleviate secondary dementia symptoms. These include drugs for anxiety and depression, as well as antipsychotic medications.²³

Leqembi and Aduhelm are infusion treatments, so they’re covered under Medicare Part B.²⁴ Cholinesterase inhibitors and memantine are covered under Medicare Part D. But each Medicare Part D plan is only required to cover at least two drugs in each category. Since there are more than two cholinesterase inhibitors, it’s important to check the plan details to see if a specific medication is covered. Medicare Part D plans will also cover antidepressants and anti-anxiety medications prescribed for the treatment of secondary dementia symptoms.²⁵

During the annual election period for Medicare Part D and Medicare Advantage (October 15 to December 7 each year), Medicare beneficiaries and their caregivers can compare the drug coverage options that are available in their area and make sure that they’re enrolled in the plan that best covers the medications they need.

What do Medigap plans cover for patients with dementia?

Medigap plans are designed to cover some or all out-of-pocket costs — deductibles and coinsurance — that a person would otherwise have to pay for services covered under Medicare Part A and Part B. Medigap plans are standardized, and the specific coverage varies by plan.²⁶

So dementia benefits under a Medigap plan will depend on the plan the person has as well as the medical care they receive. For medical care they receive that’s covered under Medicare Part A or Part B, the Medigap plan will pay out-of-pocket costs according to the plan’s rules.

With very limited exceptions, Medigap plans will not cover out-of-pocket costs for services that aren’t covered by Medicare Part A or Part B. So for example, if a patient with dementia needs memory care or other custodial long-term care, their Medigap plan will not pay any of the costs since those services aren’t covered under Medicare Part A or Part B.
[hio_question question="What is a Medicare Special Needs Plan (SNP) for dementia?"]Depending on where you live, you may have access to a Medicare Advantage Special Needs Plan (SNP) designed for patients with dementia.²⁷

But the vast majority of SNPs are for people who are dually eligible for Medicare and Medicaid, or for those with diabetes, heart disease, or lung conditions. SNPs for people with dementia are not widely available. According to a KFF analysis, only one Medicare Advantage firm offers an SNP for people with dementia in 2024, and only in four states (California, Florida, Michigan, and Virginia).²⁸

You can use the Medicare plan finder tool or call Medicare at 1-800-MEDICARE (800-633-4227) to inquire about the availability of a dementia-related SNP in your area.

Does Medicare cover hospice for dementia patients?

Yes. Like any Medicare beneficiaries, those with dementia can utilize the Medicare hospice benefit, provided under Medicare Part A, with minimal out-of-pocket costs.²⁹

Hospice coverage is available if the patient’s doctor certifies that they are expected to live no more than six months, although hospice care can be extended as long as the doctor recertifies that the patient is still terminally ill. To enter hospice, the patient has to agree to palliative care rather than curative care for the terminal illness.