Medicare does cover a meaningful range of dementia-related services, but it comes with significant gaps that catch many families off guard. For someone newly diagnosed with Alzheimer’s disease, Medicare Part B will cover a cognitive assessment and care planning visit with their doctor, and Part A kicks in for short-term skilled nursing or home health care when medically necessary. The coverage is real — but it is designed around episodic medical care, not the ongoing daily support that dementia typically requires over months and years.
To give a concrete picture: a 74-year-old woman diagnosed with moderate Alzheimer’s who needs help bathing, dressing, and eating every day will find that Medicare pays nothing for that custodial care — not at home, not in an assisted living facility, not in a memory care unit. What Medicare will cover is her doctor’s appointment to assess her cognitive function, her prescription for donepezil through a Part D plan, and potentially a course of skilled nursing following a hospitalization. The distinction between skilled medical care (covered) and custodial personal care (not covered) is the central fault line in Medicare’s dementia coverage. This article walks through each component of Medicare — Parts A, B, and D — along with newer developments like the GUIDE program, the coverage of Alzheimer’s disease-modifying drugs, and the limits families need to understand before making care decisions.
Table of Contents
- What Does Medicare Cover for Dementia Diagnosis and Cognitive Care Planning?
- How Does Medicare Cover Skilled Nursing and Home Health for Dementia Patients?
- What Prescription Drug Coverage Does Medicare Offer for Dementia?
- What Is the GUIDE Program and How Can Dementia Families Access It?
- What Does Medicare NOT Cover for Dementia — and Why It Matters
- Medicare Advantage and Dementia — An Uneven Picture
- Looking Ahead — Medicare Policy and Dementia Care
- Conclusion
- Frequently Asked Questions
What Does Medicare Cover for Dementia Diagnosis and Cognitive Care Planning?
Medicare Part B covers cognitive assessment and care planning services for people who have been recently diagnosed with cognitive impairment, including Alzheimer’s disease and other dementias. This is not simply a standard office visit — it is a billable benefit that allows a physician or qualified healthcare provider to conduct a structured evaluation of memory and function, review medications, and create a documented care plan that addresses safety concerns, caregiver resources, and referrals to community support. As of October 2023, CMS also removed the previous restrictions on amyloid PET scan coverage. Earlier policy limited these brain imaging scans to one per lifetime and required enrollment in a clinical trial.
Both restrictions have been lifted. A patient whose doctor suspects early Alzheimer’s can now receive an amyloid PET scan through Medicare without a lifetime cap and without joining a research study. This change matters most for patients being evaluated for the newer anti-amyloid therapies, where knowing whether amyloid plaques are present is a prerequisite for treatment. The care planning benefit is underutilized largely because many providers are not aware of it or have not set up their billing to capture it. If a family member has just been diagnosed and is seeing a primary care physician or neurologist, it is worth specifically asking whether a formal care plan under Medicare’s cognitive impairment benefit can be created.
How Does Medicare Cover Skilled Nursing and Home Health for Dementia Patients?
Medicare Part A covers stays in a skilled nursing facility following a qualifying hospitalization of at least three consecutive days. For the first 20 days of a skilled nursing stay, Medicare covers all costs. From day 21 through day 100, the patient owes a daily coinsurance of $209.50 (the 2025 rate). After 100 days, Medicare pays nothing — the patient is responsible for the full cost. This benefit is frequently misunderstood by families managing a dementia diagnosis. The SNF benefit exists to cover post-acute rehabilitation or skilled medical services, not long-term placement.
A person with dementia who suffers a fall, breaks a hip, is hospitalized for three nights, and then needs physical therapy and wound care at a nursing facility qualifies for this benefit. However, once the skilled care need ends — once the therapist signs off and the wound is healed — Medicare’s obligation stops, regardless of how much ongoing supervision the person needs due to dementia. Home health care follows similar logic. Medicare Part A covers up to 35 hours per week of in-home care for patients who are homebound and require part-time skilled nursing or therapy services. A dementia patient recovering from a urinary tract infection who needs a visiting nurse to administer IV antibiotics may qualify. But Medicare does not cover a home health aide who comes every day to provide companionship, reminders to take medications, or help getting dressed. Those are classified as custodial services and are excluded from Medicare coverage entirely.
What Prescription Drug Coverage Does Medicare Offer for Dementia?
Medicare Part D plans are required to cover at least two drugs in the cholinesterase inhibitor class, which includes donepezil (Aricept), rivastigmine (Exelon), and galantamine. These medications do not slow the disease — they manage symptoms by supporting chemical signaling in the brain — but they are widely prescribed and their coverage under Part D is a standard expectation. Memantine, used for moderate-to-severe Alzheimer’s, is also generally covered, though formulary placement and cost-sharing vary by plan. The more significant development in recent years involves lecanemab (brand name Leqembi), a monoclonal antibody that targets and removes amyloid plaques from the brain. The FDA granted full approval in 2023, and Medicare covers it under Part B — not Part D — with a 20% coinsurance after the deductible.
On January 26, 2025, the FDA approved a new maintenance dosing schedule of once every four weeks, which simplifies administration compared to the previous biweekly infusion schedule. Access, however, requires that the prescribing provider participate in a CMS registry, which is designed to track outcomes. Donanemab (Kisunla) is covered under the same Medicare monoclonal antibody registry policy. The registry requirement is not a bureaucratic formality. Not all neurology practices or infusion centers have enrolled, which means some patients in rural areas or smaller metro markets cannot access these drugs through Medicare even if they qualify clinically. Families pursuing lecanemab or donanemab should ask their neurologist directly whether their practice participates before assuming coverage will be available.
What Is the GUIDE Program and How Can Dementia Families Access It?
In July 2024, CMS launched the GUIDE (Guiding an Improved Dementia Experience) program, an eight-year nationwide pilot running through 2032 that provides free dementia care navigation services to eligible Medicare beneficiaries. The program is designed to address one of the most consistent complaints from dementia families: the healthcare system provides a diagnosis and then leaves families to figure out the rest on their own. GUIDE participants receive access to a care coordinator or navigator who helps the family understand available services, coordinate between providers, access respite care, and connect with community organizations. The services are free to eligible beneficiaries. To qualify, a person must have a diagnosis of moderate-to-severe dementia, must not be living in a nursing home or enrolled in hospice, and must be enrolled in Original Medicare — not Medicare Advantage.
As of July 1, 2025, participants in the New Program Track began receiving GUIDE services, and 390 organizations are participating nationwide. For families who have felt lost after a diagnosis, this is a practically significant benefit. The comparison to going without it is stark: without a navigator, a family managing a loved one’s dementia often spends weeks trying to understand what Medicare covers, what Medicaid might eventually cover, how to access adult day programs, and how to find respite care. The GUIDE program assigns someone to help with exactly those questions. The Medicare Advantage exclusion is an important limitation — if the person with dementia is enrolled in a Medicare Advantage plan rather than Original Medicare, they do not currently qualify.
What Does Medicare NOT Cover for Dementia — and Why It Matters
The coverage gaps in Medicare are not edge cases. They represent the bulk of what dementia care actually costs over time. Medicare does not cover room and board at memory care communities, assisted living facilities, or residential care homes. It does not cover 24/7 supervision at home. It does not cover companion care or personal care aides who help with bathing, dressing, toileting, or eating on an ongoing basis. For a family whose mother is in the moderate stage of Alzheimer’s and can no longer safely live alone, none of the housing-based care options — memory care communities, assisted living with memory support — are covered by Medicare.
The average monthly cost of memory care in the United States exceeds $5,000 in most markets and is substantially higher in many states. Families who assumed Medicare would step in are sometimes blindsided when they discover the program was never designed for that role. Medicaid, not Medicare, is the primary public payer for long-term custodial care. But Medicaid is means-tested, and qualifying often requires spending down assets first. Long-term care insurance, if purchased before a diagnosis, is the other main option, though premiums have risen sharply and new policies are harder to obtain. The practical warning for anyone researching Medicare coverage for dementia is this: build a financial plan that accounts for the gap between what Medicare covers and what dementia care actually costs. That gap is large and it arrives earlier than most families expect.
Medicare Advantage and Dementia — An Uneven Picture
Medicare Advantage plans are required to cover everything Original Medicare covers, but they often add supplemental benefits that could be relevant to dementia patients, such as meal delivery, transportation, and limited in-home support. The tradeoff is prior authorization, narrower provider networks, and — as noted above — ineligibility for the GUIDE program as currently structured. A family choosing between Original Medicare and Medicare Advantage for a loved one with early-stage dementia is making a real tradeoff.
The supplemental benefits of Medicare Advantage can be valuable, particularly if the plan includes any home-based care add-ons. But network restrictions may limit access to specialized Alzheimer’s care centers or academic medical programs, and the exclusion from GUIDE is a concrete disadvantage. Reviewing plan details annually during open enrollment, particularly as the dementia progresses and care needs change, is more important for this population than for most Medicare beneficiaries.
Looking Ahead — Medicare Policy and Dementia Care
The policy landscape around Medicare and dementia is moving faster now than at any point in the past decade. The GUIDE program represents the first time CMS has explicitly funded care coordination and caregiver support as a dementia-specific benefit. The approval and coverage of lecanemab and donanemab — the first drugs shown to slow cognitive decline in early Alzheimer’s — marks a genuine shift from purely symptomatic treatment to disease modification.
And the removal of the amyloid PET scan lifetime limit opens the door to earlier, more precise diagnosis. Whether these changes translate into meaningfully better outcomes depends on implementation: how many providers participate in the drug registry, whether GUIDE expands to Medicare Advantage enrollees, and how effectively care navigators reach families in underserved communities. For families navigating the system today, the most important shift is simply knowing these programs exist and asking providers whether they are equipped to access them.
Conclusion
Medicare’s coverage for dementia care is more substantial than many people realize, but it is also more limited than most people need. The program covers cognitive assessments, care planning, skilled nursing after hospitalization, some home health care, prescription drugs including newer disease-modifying therapies, hospice, and — through the new GUIDE program — free care navigation services. These are meaningful benefits, and families should use every one of them.
At the same time, Medicare was not built to finance the long-term, day-to-day custodial care that dementia eventually requires. That gap is the central financial reality of the disease, and planning for it is as important as understanding the coverage that does exist. The next step for any family is to contact their local Area Agency on Aging, review Medicare plan options during open enrollment, ask their neurologist about GUIDE eligibility, and — if they haven’t already — begin a conversation about long-term care funding before a crisis forces the issue.
Frequently Asked Questions
Does Medicare cover memory care facilities?
No. Medicare does not cover room and board at memory care communities or assisted living facilities. It may cover short-term skilled nursing services in a licensed nursing facility following a hospitalization, but ongoing residential care is not a Medicare benefit.
Does Medicare cover in-home dementia care?
Partly. Medicare covers part-time skilled nursing or therapy services at home for homebound patients with a qualifying medical need. It does not cover 24/7 supervision, companion care, or personal care aides who help with daily activities like bathing and dressing on an ongoing basis.
Is lecanemab (Leqembi) covered by Medicare?
Yes, under Medicare Part B, with 20% coinsurance after the deductible. The prescribing provider must participate in a CMS registry. Not all practices have enrolled, so patients should confirm their provider’s participation before assuming access.
What is the GUIDE program and who qualifies?
The GUIDE program is a free CMS-funded dementia care navigation program launched in July 2024. To qualify, a beneficiary must have a diagnosis of moderate-to-severe dementia, not be in a nursing home or on hospice, and be enrolled in Original Medicare — not Medicare Advantage.
Does Medicare cover amyloid PET scans for Alzheimer’s?
Yes. Since October 2023, CMS removed the previous restriction that limited coverage to one amyloid PET scan per lifetime and required enrollment in a clinical trial. The scan is now covered without those limitations.
What happens after the 100-day skilled nursing benefit runs out?
After 100 days in a skilled nursing facility, Medicare pays nothing. The patient is responsible for the full cost of the stay. Days 21 through 100 already require a daily coinsurance of $209.50 (2025 rate). Families should plan for this transition well before it occurs.
