Dual eligibles rely on Medicaid for long-term memory care because Medicare does not pay for ongoing custodial care. Medicaid pays for those daily nursing and personal-care services for people enrolled in both programs.
Dual eligible means a person enrolled in both Medicare and Medicaid. KFF estimates about 12 million Americans hold both coverages. The group includes low-income seniors and younger people who qualify by age, disability, and low income.
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 Usc — Use this primary source to verify the official guidance.
Table of Contents
- What does Medicare leave unpaid?
- How does Medicaid fill the gap?
- How high are dementia care costs?
- What should families verify?
What does Medicare leave unpaid?
The Centers for Medicare & Medicaid Services explains on its long-term-care coverage page that Medicare does not pay for long-term custodial care. That gap includes daily help many people with dementia need for months or years.
The Centers for Medicare & Medicaid Services also limits nursing-home coverage under Original Medicare. It covers only short-term skilled nursing or home-health care after illness or injury when conditions are met. It does not cover custodial care when that is the only care needed.
- bathing and dressing help
- meals, adult day care, and transportation
- nursing-home and community-based long-term care
How does Medicaid fill the gap?
The Medicaid and CHIP Payment and Access Commission says on its dually eligible beneficiaries page that Medicaid wraps around Medicare for dually eligible people. It helps with Medicare premiums and cost-sharing. It also covers services Medicare normally excludes, including long-term nursing and personal care.
That wrap-around matters for memory care. Dementia often creates need for supervision, personal care, and nursing support rather than brief medical treatment. Medicaid pays for that ongoing care layer.
How high are dementia care costs?
The USC Schaeffer Center visualization puts 2023 per-person medical and long-term-care spending for fee-for-service beneficiaries with dementia at about $54,500 for dual eligibles. That level sits substantially above spending for Medicare-only beneficiaries. The difference reflects greater health needs and longer care use. The USC Schaeffer Center estimates in its 2026 dementia cost study summary that total U.S. dementia costs reach $818 billion in 2026.
Medical and long-term care account for $222 billion of that total. Medicare and Medicaid cover about 70 percent, or $154 billion, while patients and families pay 20 percent, or $46 billion, out of pocket. The Alzheimer's Association estimates lifetime care for one person with dementia at about $405,262. It attributes roughly 70 percent to families through unpaid care and out-of-pocket spending. That burden makes prolonged memory care unaffordable without public coverage.
What should families verify?
The Centers for Medicare & Medicaid Services notes that Medicaid long-term-care eligibility and covered settings vary by state income, asset, and functional rules. Not every dual eligible receives full long-term-care benefits automatically.
Coverage depends on meeting state tests and qualifying needs. Ask the state Medicaid agency what level of long-term care the person qualifies for before arranging extended memory care.
- confirm income and asset rules in your state
- confirm functional need tests for nursing or personal care
- confirm which settings are covered: nursing home, home, or community-based care
