Does Medicare cover memory care?

 

memory care
memory care.PHOTO COURTESY/Instagram

If you or someone you know has challenges with Alzheimer’s or other forms of dementia, memory care facilities provide specialized support in a residential setting.

Unfortunately, Medicare coverage for memory care is limited.

Medicare covers the cost of certain medical services and treatments for people with memory impairments, but it doesn’t cover long-term care.

Read on to learn more about what specific services are covered by Medicare.

What is memory care?

Memory care facilities provide structured environments where people with Alzheimer’s or other forms of dementia can live safely and engage in programs that address their needs.

These long-term care facilities have trained staff, a secure and supportive space, and a daily, specialized agenda for people with memory impairments.

  • The difference between memory care facilities and assisted living

In assisted living facilities, adults are generally expected to manage their own time with assistance as needed.

Residents can move about freely inside and outside the place.

Some assisted living facilities also provide care for people with memory challenges, but there’s often less specialized programming.

How much memory care costs

The costs of a memory care facility can vary depending on the state you live in and the specific facility, but you can expect to pay $6,160 or more per month in the U.S.

While Medicare can help pay for any medical services and treatments the facility provides, residents generally have to pay out-of-pocket for remaining memory care costs.

If you’re interested in exploring memory care as an option, it’s important to research and plan as early as possible.

Does Medicare cover memory care?

Medicare won’t cover long-term care costs associated with memory care such as room and board or personal care within the facility.

Medicare does cover any medical services that the memory care facility provides and any general services needed by people with cognitive impairments.

Original Medicare and Medicare Supplement coverage

  • Original Medicare Part A (hospital or in-patient insurance) can cover:

The first 100 days in a skilled nursing facility following a hospital admission.

Medicare also covers nursing home care

Hospice care for people determined to have 6 months or less to live.

  • Original Medicare Part B can cover:

​​Any medical services related to treating Alzheimer’s and other kinds of dementia

Medicare Supplement (Medigap) helps to cover any out-of-pocket expenses for services and treatments that Original Medicare doesn’t pay for (about 20% of costs after you’ve met your Part B deductible).

Medicare Advantage coverage

By law, Medicare Advantage plans will cover any service and treatment that Original Medicare provides, so Medicare Advantage has the same limited coverage of memory care.

When choosing a Medicare Advantage plan, it’s important to understand the downsides of Medicare Advantage plans.

These plans often require prior authorization for covered services.

Each plan also has different cost structures (different deductibles and coinsurance), so it’s important to know how the services you need are covered before receiving care.

Medicare Part D

Medicare Part D provides people with prescription drug coverage.

You can obtain Part D coverage either through a standalone plan or through a Medicare Advantage plan that includes it.

Each prescription drug plan is different and covers a different list of drugs.

This is why it’s important to review the details of your Part D coverage every year to be sure the drugs you need are covered.

Resources for financial assistance

There are a few options you can explore to get coverage for memory care.

Even with these resources, memory care can be expensive, and getting financial assistance can be complicated.

Planning and talking to an elder law attorney can help you discover more about memory care.

  • Medicaid

Medicaid will cover some costs of memory care, including specialized memory care units in nursing homes

Navigating Medicaid can be a complex process depending on the state you live in.

Connect with your local agency to see if you qualify.

  • Long-term care insurance

Long-term care insurance is a type of insurance that helps cover the costs of long-term care service facilities

Certain providers can reimburse you for memory care, but check the details and understand your policy fully before buying.

  • Veterans benefits

Veterans who need memory care can get coverage through the VA Health System based on certain eligibility requirements.

Memory care is expensive, especially since there are limited options for coverage with Medicare.

If you still have questions, we can help! Call us at (855)-900-2427 to talk to one of our licensed Advisors and get more information on what Medicare covers.

 

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