Medicaid and Medicare Memory Care Coverage

Does Medicare Cover Memory Care?

There are over 65 million Americans enrolled in Medicare,1 and many use Medicare as their primary health insurance. Medicare covers some memory care services, but not all, and the out-of-pocket costs can be significant. When it’s time to seek memory care treatment, enrollees may be unaware of Medicare’s lack of coverage.

Memory care falls under Medicare’s long-term care (also known as custodial care). Unfortunately, Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don’t pay for long-term care.2

Memory Care Services Covered by Medicare

Original Medicare (Part A and Part B) may cover some memory care services, including these:

• Cognitive impairment assessment, diagnosis, and person-centered care planning services
• Annual wellness visits (12 months after your enrollment in Medicare Part B)
• Inpatient hospitalization to treat an injury or illness
• Up to 100 days of skilled nursing care (must meet Medicare requirements)
• Durable medical equipment (DMEs)
• Home health care
• Hospice care costs for pain relief and management in end-stage dementia
• Inpatient care for clinical research studies

Additional Memory Care Coverage Options

Original Medicare comes with out-of-pocket costs such as deductibles, copayments, and coinsurance. Prescription medications are not covered under Original Medicare.

Before you begin imagining a pile of medical bills, know that Original Medicare isn’t your only option. Medicare also contracts with private insurance companies. These Medicare-approved private policies may aid in reducing out-of-pocket expenses.

• Medicare Part C (Medicare Advantage Plans): Medicare Part C includes Part A, Part B, and often Part D coverage. Some Medicare Part C plans also provide dental and vision benefits.
• Medicare Part D (Prescription Drug Plans): Medicare Part D is a prescription drug plan. Visit SeniorLiving.org’s picks for Medicare Part D plans to learn more.
• Medicare Special Needs Plans (SNPs): Medicare SNPs offer the same benefits as Medicare Part C plans. However, they may cover extra services tailored to the special groups they serve, including dementia patients.
• Medicare Supplement Insurance (Medigap): Medicare Supplement Insurance helps fill in the gaps that Original Medicare doesn’t cover. Check out our top picks for Medigap plans to learn more.

Does Medicaid Cover Memory Care?

Over 83 million people in the U.S. receive Medicaid benefits.3 Medicaid aids low-income individuals with limited financial resources. Your age, disability status, and family size may also factor into Medicaid approval.

Memory care falls under Medicaid’s nursing facility services. Nursing facility care is covered under Medicaid, so memory care is as well. How memory care is delivered may vary by state, though. For example, some states may provide long-term nursing care in the home or within Medicare-approved senior living facilities, while other states may only provide one option.

Memory Care Services Covered by Medicaid

As Medicaid is a joint federal and state benefit, certain Medicaid benefits are federally mandatory. In addition to these mandatory Medicaid benefits, states have the option to provide extra benefits. Check with your State Medicaid Agency to take advantage of all memory care benefits available to you or your loved one.

Mandatory Medicaid memory care services include the following:5

• Nursing facility services (including memory care)
• Inpatient hospital services
• Outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Home health services
• Physician services
• Prescription drugs
• Federally qualified health center services
• Laboratory and X-ray services
• Transportation to medical care

How Do I Pay for Memory Care?

There are many pieces in the memory care puzzle, so it’s essential to ask for help from your hospital discharge planner, care coordinator, or social worker. They often have resources for programs or facilities that work with those who can’t afford memory care’s out-of-pocket costs.

Since only a portion of memory care is covered by Medicare and Medicaid, older adults must find supplemental ways to pay for memory care costs. The Alzheimer’s Association recommends exploring these resources:

• Long-term care insurance or other private insurance
• Retirement funds
• Personal savings and assets
• Social Security Disability Insurance (SSDI)
• Supplemental Security Income (SSI)
• Veterans benefits
• Tax deductions and credits

Interested in learning more about the benefits of long-term care insurance? Jeff Hoyt, our editor-in-chief, explains how to shop for and choose the right long-term care insurance in the video below.

What if I Can’t Afford Memory Care Coverage?

Older adults living on a fixed income may not have the personal savings to supplement mounting memory care costs. No matter your situation, check with these Medicare and Medicaid programs to see if you qualify for additional financial aid:

• Medicare Savings Programs
• Program of All-Inclusive Care for the Elderly (PACE)
• Medicare Part D Extra Help

Where Can I Find Medicaid and Medicare Memory Care Services Near Me?

As you begin your search for a memory care facility, remember that some facilities choose not to accept Medicaid or Medicare. It’s essential to confirm the facility is a Medicare- or Medicaid-approved center for memory care services.

Your care planning team through Medicaid or Medicare is an excellent resource to help you find the right memory care facility for your own or your loved one’s needs. You can contact Medicaid or Medicare directly for confirmation of coverage to ensure you have the latest memory care coverage information.

• Medicaid recipients: Contact your State Medicaid Agency.
• Medicare recipients: Call 1-800-MEDICARE (800-633-4227). TTY users call 877-486-2048.

Through Medicare’s Find & Compare search tool, you can also review ratings for local nursing homes and health agencies, and obtain estimates for doctors’ costs in your area. You will need to have (or create) a secure Medicare account to use this search feature.