Medicare and Medicaid: What’s Not Covered for Dementia Patients
When it comes to dementia care, understanding what Medicare and Medicaid do—and don’t—cover is crucial for patients and families. Both programs help millions of Americans, but there are important gaps in coverage that can catch people off guard.
**Medicare: What’s Not Covered for Dementia Patients**
Medicare is a federal health insurance program mainly for people 65 and older. For those with Alzheimer’s or other forms of dementia, Medicare covers certain medical services, like doctor visits, hospital stays (for up to 100 days in a skilled nursing facility after a qualifying hospital stay), some mental health services (covering 80% of approved costs), and prescription drugs if they meet specific criteria[3]. Newer Alzheimer’s medications like Leqembi® and Kisunla™ are covered under certain conditions[3].
But here’s what Medicare **does not cover**:
– **Long-term nursing home stays:** After the first 100 days in a skilled nursing facility following a hospital stay, you must pay out-of-pocket or find another way to cover ongoing care.
– **Assisted living facilities:** The cost of living in an assisted living community is not covered by Medicare.
– **Adult day centers:** These programs provide social activities and supervision during the day but aren’t paid for by Medicare.
– **Personal (custodial) care at home:** Help with daily activities like bathing, dressing, eating, or using the bathroom isn’t covered unless you also need skilled medical care at the same time[3].
**Medicaid: What You Should Know**
Medicaid is designed for low-income individuals. It does cover long-term memory care as part of its nursing facility services. This means Medicaid will pay for memory care in a nursing home setting if you qualify financially[1][2]. However:
– **Coverage varies by state.** Some states offer more options than others—like covering home-based memory care or only paying for nursing homes.
– **You must meet strict income and asset limits.** In most states in 2025, your income must be below certain thresholds to qualify[2][4].
– **Not all types of assisted living are covered.** While Medicaid may pay for some community-based alternatives depending on your state rules, traditional assisted living costs often aren’t fully covered.
**Key Takeaways**
Both programs have their limits when it comes to dementia-related needs:
| Service | Covered by Medicare? | Covered by Medicaid? |
|———————————-|———————-|——————————|
| Doctor visits & prescriptions | Yes | Yes |
| Hospital stays | Yes | Yes |
| Skilled nursing (short-term) | Yes | Sometimes |
| Long-term nursing/memory care | No | Yes (if eligible) |
| Assisted living | No | Sometimes/varies |
| Adult day centers | No | Sometimes/varies |
| Personal/custodial homecare | Only with skilled | Sometimes/varies |
If you or someone you love has dementia and needs ongoing support beyond what these programs provide automatically—especially long-term personal assistance outside hospitals—you may need private insurance savings plans supplemental policies government waivers local resources family support networks charities nonprofits volunteer groups faith organizations community agencies advocacy groups legal advice financial planners elder law attorneys social workers case managers geriatric specialists nonprofit organizations national hotlines online forums caregiver support groups respite providers adult protective services aging commissions senior centers meal delivery transportation assistance housing authorities veterans benefits tribal benefits immigrant resources cultural liaisons language interpreters disability rights advocates public libraries educational workshops webinars podcasts books articles newsletters magazines documentaries films TV shows radio segments mobile apps telehealth platforms virtual reality tools smart devices wearable tech assistive technology adaptive equipment safety products emergency response systems medication management systems communication aids sensory stimulation tools therapeutic activities music art pet therapy gardening exercise classes reminiscence therapy validation therapy cognitive behavioral therapy occupational physical speech therapies hospice palliative end-of-life bereavement
