Medicare covers dementia diagnosis, care planning, and some early Alzheimer's treatment, but not long-term daily care. Families need to know which visit to request, what treatment rules apply, and which costs stay with them. Dementia means ongoing loss of memory and thinking skills that interferes with daily life. Medicare pays for medical care for these conditions under specific rules, not for ongoing supervision or household help.
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 Medicare’s official study page — Use this page to check the study’s participation requirements.
- Read the official guidance from Medicare — Use this primary source to verify the official guidance.
Table of Contents
- How do you get checked and make a plan?
- Does Medicare cover new Alzheimer's drugs?
- What help exists beyond doctor visits?
- What will Medicare not pay for?
How do you get checked and make a plan?
Medicare.gov says Part B covers a yearly Wellness visit that includes screening for cognitive impairment Yearly Wellness Visits. If that screening suggests a problem, Medicare covers a separate, more thorough cognitive review and care-plan visit.
Medicare.gov says Part B also covers a separate cognitive-assessment visit to review memory and decision-making, establish or confirm dementia or Alzheimer's disease, and create a symptom and advance-care plan cognitive assessment and care-plan services. The patient pays 20% after the Part B deductible for this visit.
- Ask for the yearly Wellness visit first for screening.
- If memory concerns continue, ask about the separate assessment and care-plan visit.
- Bring medication lists, daily examples of problems, and a family member who sees the changes.
Does Medicare cover new Alzheimer's drugs?
Medicare.gov says Part B may cover FDA-approved anti-amyloid antibodies Leqembi and Kisunla for early Alzheimer's only with confirmed amyloid plaques plus mild cognitive impairment or mild dementia monoclonal antibody coverage for early Alzheimer's. Coverage includes 20% cost-sharing plus added scan costs. The same Medicare.gov coverage page requires the prescribing provider to collect treatment evidence for a qualifying CMS study or registry.
Families must confirm registry participation before expecting Part B payment. This is a narrow path. It does not apply to moderate or severe dementia, or to Alzheimer's without confirmed plaques. Ask the clinic in writing whether the drug, scans, and registry status meet Medicare rules.
What help exists beyond doctor visits?
CMS launched its 8-year GUIDE Model on July 1, 2024 for community-dwelling Traditional Medicare beneficiaries. Participating dementia programs provide a care navigator, 24/7 support, caregiver training, and respite reimbursement up to $2,500 per year. Effective Oct.
13, 2023, CMS retired national determination 220.6.20 for beta-amyloid PET imaging. That action ended coverage-with-evidence-development and left coverage decisions to regional Medicare Administrative Contractors. For families, the practical step is direct: ask whether your provider participates in GUIDE, and ask your regional contractor about PET coverage before scheduling a scan.
What will Medicare not pay for?
Medicare does not pay for long-term custodial care. That includes help with dressing, bathing, meals, adult day care, or nursing-home room and board when only supervision is needed. Families pay all such costs or seek Medicaid or private insurance.
For drugs, CMS set a $2,100 yearly cap for 2026 on enrollee out-of-pocket spending for covered Part D drugs. After that limit, enrollees in the catastrophic phase pay no cost-sharing, which limits drug costs for dementia medications. Plan for daily-care costs separately from medical coverage. Check Medicaid eligibility, private long-term-care insurance, and local respite programs before care needs become urgent.
