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Medicare covers some—but not all—costs associated with dementia and long-term care.

Finding the right level of care and support for a loved one struggling with dementia is a deeply personal experience. It’s a responsibility that carries an immense amount of pressure—especially when it comes to fronting the bill.

There’s a lot that goes into factoring in the potential costs. Still, generally speaking, memory care will cost between 20% and 30% more than assisted living, depending on a variety of factors:

  • Location
  • Services
  • Amenities
  • Programming 

We understand this can be overwhelming, and it’s no surprise that many find themselves combing over all their expenses and asking whether or not memory care facilities accept Medicare.

The short answer? Yes, Medicare does help relieve some of the burden associated with dementia costs.

That said, there are a lot of specifics to consider—particularly when it comes to long-term care—and the fine print is a little more nuanced. 

In other words, Medicare covers some—but not all—costs in a memory care facility.

We’ll break it all down so you have a better idea as to what you can expect, but first, it’s important that you understand what dementia actually is.

What is Dementia?

Dementia is a generalized term, not a specific disease, under which a number of diseases (including Alzheimer’s) can fall. These diseases include Lewy body dementia, Vascular dementia, Parkinson’s, and Alzheimer’s, just to name a few.

It’s a serious condition that results in a drastic decline in memory, reasoning skills, attention span, and communication skills. 

Its reach is long, too, and the World Health Organization says that 55 million people—worldwide—live with one form or another of dementia.

While we’ve yet to determine a specific cause and find a cure, it’s important to know all the warning signs of dementia so you can get an early diagnosis and start planning for the future.
Because, as symptoms become more severe, your loved one may need specific treatment and support in your choice of memory care facilities.

Medicare & Memory Care

So, does Medicare cover memory care facilities? 

Medicare is a federally funded health insurance plan for U.S. citizens and legal residents who are at least 65 years of age or older. What many don’t know is that the right coverage helps pay for some services (prescription drugs, hospice, cognitive evaluations, etc.) at every stage of dementia.

Here’s a high-level overview of what is and isn’t covered:

Part A: Covers inpatient hospital care, skilled nursing facility care, nursing home care, hospice care, and home health care.

  • Pays for up to 35 hours per week of home health care.
  • Pays for the first 100 days in a Skilled Nursing Facility (SNF). 
    • This cost does not include a deductible. There is no cost for the coinsurance for days 1 through 20. 
    • After 100 days, you are responsible for the full cost.

Part B: Pays for outpatient care, occupational therapy, medical equipment, and testing. 

  • Covers tests, doctor visits, and medical items in the early stages of dementia.
    • There is no deductible or coinsurance.
    • Annual Part B deductible of $203 applies.

Part C (Medicare Advantage): Covers vision/dental insurance, and mental health services.

  • Includes services that Medicare Part A and Part B also cover. May also include additional benefits, including transportation to and from appointments. 
  • A Special Needs Plan (SNP) provides benefits that are specific to dementia.

Note: Deductibles, copayments, and coinsurance may differ from those in original Medicare. Medicare Advantage plans vary in a number of ways. Make sure you read each policy’s explanation of benefits to make the most informed decision. 

Part D: Provides access to a network of pharmacies and prescription drugs in exchange for a monthly premium. This is applicable throughout every phase of dementia.

Now, here’s something to think about—you can start coverage before the illness starts to develop. 

How?

By taking advantage of wellness visits to develop a personalized plan to keep dementia at bay for as long as possible. It’s a preventative measure that we highly recommend.

The Moments Memory Care Facility

At The Moments, we specialize in care for older adults living with Alzheimer’s and other forms of dementia. We take 5-star hospitality standards and combine them with high-acuity specialized clinical services.

We also include customized dining programs, daily housekeeping, and a person-centered approach to programming. 
For more information, contact us today!

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