Yes. If your usual doctor does not participate in GUIDE, you can choose a separate GUIDE dementia provider or care team in your area. GUIDE, a CMS dementia care model, does not require you to stop seeing Medicare-accepting doctors or hospitals.
Start by finding a participating program that serves the patient's address, then ask that program about a comprehensive assessment and enrollment. The GUIDE provider can assess the person even when the usual doctor is outside the program, while CMS makes the final eligibility decision. CMS explains these choices in its GUIDE FAQs.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- Check eligibility on CMS’s official study page — Use this page to check the study’s participation requirements.
- Read the official guidance from CMS — Use this primary source to verify the official guidance.
Table of Contents
- How to Find a GUIDE Provider
- What Happens After You Choose a Team?
- Can You Keep Your Usual Doctor?
- Who Usually Qualifies?
- What Services Can the Program Provide?
- Frequently Asked Questions
How to Find a GUIDE Provider
CMS publishes a participant list showing GUIDE programs by state. The list does not guarantee that every program serves every address because each participant sets its own ZIP-code service area. Use the list to identify nearby programs, then contact each one directly.
Confirm that the program serves the patient's address, accepts new participants, and can provide the needed services. A program may use a different organization or clinical team than the patient's regular doctor. The key issue is whether the program participates in GUIDE and serves the patient's location. CMS's GUIDE Participant List provides the state-level starting point.
What Happens After You Choose a Team?
Enrollment begins with the patient's voluntary consent to receive GUIDE services from that specific participant. The provider then submits the person's information, and CMS confirms whether the person qualifies. The GUIDE provider—not necessarily the usual doctor—can complete the required comprehensive assessment.
CMS allows the assessment to occur in person or virtually, but the assessment itself does not guarantee enrollment. Ask the program what records it needs and how it will coordinate with the patient's existing doctors. Choosing a GUIDE provider does not transfer all medical care to that team.
Can You Keep Your Usual Doctor?
Yes. GUIDE participation does not change regular Medicare benefits or restrict access to other Medicare clinicians. A person can continue seeing Medicare-accepting doctors and hospitals while receiving GUIDE services from a separate participating team.
GUIDE is voluntary. A person does not have to remain enrolled and may stop participating at any time. This makes a separate provider a practical option when a trusted primary-care doctor, neurologist, or other usual clinician does not participate. The GUIDE team can add dementia-care coordination without replacing the patient's broader Medicare care.
Who Usually Qualifies?
Eligibility generally requires clinician-confirmed dementia, Original Medicare Parts A and B as the primary payer, and residence in a private home or a qualifying partnered residential-care community. Before arranging an assessment, check these basic requirements: Several situations prevent eligibility, including Medicare Advantage, PACE enrollment, a Medicare hospice election, long-term nursing-home residence, memory-care-unit residence, or current alignment to another GUIDE participant.
CMS lists these eligibility rules in its GUIDE FAQs. CMS, rather than the provider alone, makes the final eligibility determination. If the person's insurance, residence, or care setting changes, ask the GUIDE program whether eligibility changes too.
- The person has clinician-confirmed dementia.
- Original Medicare Parts A and B are the primary payer.
- The person lives at home or in a qualifying partnered residential-care setting.
- The person is not already aligned with another GUIDE participant.
What Services Can the Program Provide?
Participating programs must use interdisciplinary teams that provide coordinated dementia care. Services include care navigation, 24/7 access, caregiver support, and connections to community resources. Qualifying respite services may be covered up to $2,500 annually and cannot be charged to aligned patients.
Ask the program which respite services qualify and how the benefit is arranged. GUIDE is an active but time-limited CMS model test scheduled from July 1, 2024, through June 30, 2032. Its benefits and effects are still being evaluated, so participation is not the same as receiving a permanent Medicare benefit. CMS describes the model and its current limits.
Frequently Asked Questions
Do I need my regular doctor's referral?
The verified CMS information supports choosing a separate GUIDE provider and receiving its assessment. Ask the selected program whether it requires additional records or steps.
Does joining GUIDE change my Medicare coverage?
No. GUIDE does not change regular Medicare benefits or restrict other Medicare clinicians.
