Medicare and Medicaid are two different US government-sponsored healthcare programs. Medicare is primarily based on age or disability status while Medicaid is based on financial need.

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicaid, on the other hand, is a joint federal and state program that provides health coverage to low-income individuals and families. Eligibility for Medicaid is based on income and assets and can vary by state.

Both Medicare and Medicaid provide coverage for some aspects of dementia care, but there are differences in their coverage.

Medicare, as a federal health insurance program, covers certain medical services for people with dementia, such as doctor’s visits, hospital stays, and prescription drugs. However, it does not cover long-term care services, such as nursing home care, which is often a significant cost for people with dementia.

Medicaid, on the other hand, does cover long-term care services for those who meet the financial eligibility requirements, including nursing home care for people with dementia. Medicaid also provides more comprehensive coverage for people with low income and limited assets, whereas Medicare has certain out-of-pocket costs, such as deductibles and co-payments.

Medicaid will cover the cost of assisted living for individuals with dementia who meet certain eligibility requirements, such as being 65 years of age or older, having limited income and assets, and requiring a certain level of care. However, Medicaid coverage for assisted living and long-term care services can vary widely from state to state, so it’s important to check with your state Medicaid office to determine what is covered in your specific area. Additionally, Medicaid often has waiting lists for these services, so it’s important to plan ahead and start the process as early as possible.

Does Medicare Cover Dementia Assisted Living?

Medicare does not typically cover the cost of assisted living or long-term care services in a residential setting, including for those with dementia. Medicare is a federal health insurance program that is primarily designed to cover hospital and medical expenses. It may cover certain limited types of inpatient rehabilitation or skilled nursing care in certain circumstances, but it does not cover ongoing custodial care in an assisted living facility.

If your loved one suffering from Alzheimer’s Disease or Dementia requires ongoing custodial care, you may want to consider Medicaid as an option, as Medicaid may cover the cost of assisted living for those who meet the eligibility requirements. However, it is important to note that Medicaid coverage for assisted living can vary by state, so it’s important to check with your state Medicaid office to determine what is covered in your area.

Generally speaking, Medicaid provides more comprehensive coverage for people with dementia, including long-term care services, whereas Medicare provides coverage for certain medical services, but not long-term care.