A loved one with memory impairment often requires specialized care to support daily living as symptoms progress. One of the most common concerns from caregivers and family members is whether Medicare will cover memory care costs. Understanding what’s covered—and what isn’t—can help you plan for your loved one’s needs.
Medicare can cover some but not all of the costs associated with memory care. Besides Medicare, there are alternative ways to fund care for a loved one.
What Is Memory Care?
Memory care is a specialized type of assisted living designed to provide a safe and supportive environment for individuals experiencing various cognitive conditions, such as Alzheimer’s disease and other types of dementia.
Memory care programs in senior communities offer assistance with daily living activities, structured routines to minimize confusion, and staff specially trained to handle cognitive decline. Memory care is vital because it not only cares for a loved one’s needs but also supports their safety, dignity, and emotional well-being.
Does Medicare Cover Memory Care?
Medicare is a federal health insurance program that can cover certain medical aspects of memory care. However, it doesn’t pay for long-term memory care or assisted living costs. Here’s a breakdown of what Medicare does and doesn’t cover.
Medicare covers the following:
- Medical care related to cognitive conditions: Doctor or healthcare provider visits to review cognitive function, tests to confirm a diagnosis, develop a care plan, and some outpatient treatments may be covered under Medicare Part B.
- Hospital stays: If your loved one requires hospitalization due to their condition, Medicare Part A can cover the associated costs.
- Short-term skilled nursing care: Medicare might cover short-term skilled nursing care after hospitalization, but this does not extend to long-term residential memory care.
- Drug coverage: Medicare Part D can cover many prescription drugs and additional dental, eye, and hearing care coverage.
- Home health services: Medicare may cover in-home health care services, such as therapy or nursing care, if a doctor deems them medically necessary.
Medicare doesn’t cover the following:
- Long-term residential care: The costs of staying in a memory care community, including personal care and housing, are not covered by Medicare.
- Non-medical support: Assistance with activities like bathing, dressing, or meal preparation in a memory care community isn’t included in Medicare benefits.
While Medicare provides valuable resources for managing health-related aspects, it has significant limitations in financing long-term residential memory care.
Alternatives & Additional Financial Support
While Medicare doesn’t cover memory care, the following options can help pay for vital services and long-term care:
- Medicaid: Medicaid, a state and federally funded program, often covers long-term care, including memory care, for eligible individuals with limited income and resources. This program can vary by state.
- Veteran’s benefits: If your loved one is a veteran or the surviving spouse of one, they may qualify for financial assistance through the Department of Veterans Affairs (VA).
- Long-term care insurance: If your loved one has this type of insurance policy, it may provide coverage for memory care. Review insurance policies carefully to check coverage and clarify the benefits with the insurance provider.
- Private pay and savings: Many families use personal savings or sell assets to pay for memory care. Some communities may also offer payment plans for more flexibility.
Tips for Navigating Memory Care with Medicare
Consider the following tips to navigate available resources.
Speak to a Medicare Advisor
Reach out to a Medicare representative or seek guidance from an elder care counselor to better understand the benefits your loved one is entitled to.
Explore Medicare-Covered Services
While memory care isn’t covered, you can use Medicare for covered medical services, like in-home health care or cognitive assessments.
Research Medicaid Options
Start the application process early if your loved one may qualify for Medicaid. The process can take time, so it’s better to be proactive.
Leverage Local Resources
Many communities have support programs for family caregivers, such as respite care or financial counseling. Organizations like the Alzheimer’s Association can also offer invaluable assistance.
Compare Communities
When choosing a memory care community, ask about alternative payment options, sliding scales, or partnerships with government-funded programs that could ease the financial stress of paying for memory care.
Personalized Wellness in Memory Care
Dealing with memory care decisions can be challenging for family members, but you don’t have to do it alone. Understanding Medicare coverage and how it works can help you plan ahead and look for alternative funding sources to care for your loved one.
Contact The Grande at Creve Coeur for more information on our memory care program and how we can help you make informed care decisions for a loved one with cognitive decline.
