Medicare policies treat dementia care with a combination of medical coverage, assessments, therapies, and some home health services, but they do not cover long-term custodial care, which is often needed as dementia progresses with age. The approach is designed to support medical needs and skilled care rather than ongoing daily personal care.
Medicare Part B (medical insurance) covers **cognitive assessments** to detect dementia early and monitor its progression. These assessments are part of annual wellness visits and include follow-up visits to discuss results and develop care plans tailored to the patient’s condition. Medicare also covers **depression screenings** once a year, recognizing that mental health issues often accompany dementia. Prescription drugs used to treat dementia symptoms, such as cholinesterase inhibitors and NMDA receptor antagonists, are covered under Medicare Part D plans, which supplement traditional Medicare’s limited drug coverage.
For patients who qualify, Medicare covers **home health care services** under strict conditions: the patient must be homebound, require intermittent skilled nursing or therapy (physical, speech, or occupational), and have a doctor’s order. This care can include skilled nursing tasks like wound care or medication management, therapy to maintain or improve function, and some supportive services such as home health aides when paired with skilled care. However, Medicare does not cover custodial care like help with cooking, cleaning, or continuous 24-hour supervision, which are often necessary for advanced dementia patients.
Medicare Part A covers **hospital stays** and up to 100 days of skilled nursing facility care after a qualifying hospital stay, which can be important for dementia patients who experience injuries or illnesses requiring inpatient care. Hospice care is also covered for end-stage dementia to manage pain and symptoms.
For individuals who are dually eligible for both Medicare and Medicaid, specialized Medicare Advantage plans called Dual Eligible Special Needs Plans (D-SNPs) and Fully Integrated Dual Eligible SNPs (FIDE-SNPs) offer better coordination of benefits and services. These integrated plans have been shown to reduce hospital readmissions and preventable hospitalizations, improving outcomes for people with dementia who often have complex medical and social needs.
Medicare’s limitations in covering long-term custodial care mean that many dementia patients and their families must look to other resources, such as Medicaid (which covers long-term care for those who qualify financially), private long-term care insurance, or supplemental Medicare plans like Medigap or Medicare Advantage plans that may offer additional benefits. Some newer Medicare programs, lik
