After an Alzheimer's diagnosis, Medicare Part B covers visits to confirm dementia and build a symptom care plan. Part B is the medical-visit part of Medicare, and it may also cover early-stage infused drugs, while Part A covers hospice for terminal illness. According to Medicare.gov, coverage stops short of daily custodial care. Families still need a separate plan for ongoing supervision, personal care, and caregiver support.
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:
- Read the official guidance from Medicare — Use this primary source to verify the official guidance.
- Read the official guidance from Medicare — Use this primary source to verify the official guidance.
Table of Contents
- How is the diagnosis confirmed and planned?
- Can Medicare cover Leqembi or Kisunla?
- What daily care costs stay with families?
- Where can families get coordinated help?
How is the diagnosis confirmed and planned?
Medicare.gov says Part B covers a yearly Wellness visit that includes a check for dementia and Alzheimer's signs. If that check suggests impairment, Part B covers a separate, more thorough cognitive review. Medicare.gov outlines a separate cognitive assessment and care-plan visit to establish or confirm dementia, create a symptom care plan, and update advance-care planning.
Advance-care planning means recording wishes for future medical care. That visit also includes referrals to specialists and community resources. The visit covers four practical tasks: Medicare.gov notes that after the Part B deductible is met, patients typically pay 20 percent of the Medicare-approved amount for this visit.
- confirm dementia or Alzheimer's disease
- create a symptom care plan
- update advance-care planning
- refer to specialists and community resources
Can Medicare cover Leqembi or Kisunla?
Medicare.gov says Part B may cover FDA-approved anti-beta-amyloid monoclonal antibodies such as Leqembi and Kisunla. Monoclonal antibodies are lab-made drugs that target amyloid, a protein that forms plaques in the brain. The drugs may slow early Alzheimer's symptoms but do not cure or reverse disease.
Coverage applies only in early disease, as described in Medicare rules for early Alzheimer's drugs from Medicare.gov. Patients need confirmed beta-amyloid plaques plus mild cognitive impairment or mild dementia due to Alzheimer's. The treating provider must also submit treatment evidence to a qualifying CMS study or registry.
What daily care costs stay with families?
Medicare.gov explains in its long-term care coverage rules that Medicare does not pay for long-term custodial care. Custodial care means help with bathing, dressing, toileting, meals, or supervision.
The exclusion applies at home, in assisted living, and in a nursing home. Medicare may cover only short-term skilled nursing or home-health care that meets strict conditions. Families should expect to pay separately for ongoing personal care and supervision or seek other local programs.
Where can families get coordinated help?
Medicare.gov says Part A covers hospice for terminal illness certified at six months or less when the patient elects comfort care. Hospice means care focused on comfort rather than cure. Covered hospice services generally have no charge to the patient.
For earlier stages, CMS describes an 8-year GUIDE Model launched July 1, 2024, with 390 participating groups in its GUIDE dementia care announcement. Eligible beneficiaries can receive care coordination, a navigator, 24/7 access, caregiver education, and respite. Respite means short-term relief for caregivers. Ask the provider whether its practice participates.
