Will Medicare Cover Assisted Living for Dementia Patients?
Unfortunately, Medicare does not cover long-term care services for dementia patients at an assisted living facility. That means they won’t cover the cost of room and board or services related to personal care, but Medicare may be able to cover some health care costs you receive in an assisted living facility.
Medicare and Memory Care
An assisted living facility provides personal care and assistance with activities of daily living to seniors, whereas a memory care facility focuses on providing specific care tailored to a patient’s care plan, safety assessment, or individual diagnosis. According to Genworth, the national monthly median cost for an assisted living facility is $4,500. On average, memory care costs 30 percent more than assisted living facilities, depending on your location.
The key thing to remember with Medicare is that it only covers “medical” needs. Some facets of memory care are medical in nature (tests, medications, etc.), but the majority of support received in memory care would fall under the umbrella of personal and custodial care.
Medicare Special Needs Plans (SNPs)
As a type of Medicare Advantage Plan, Medicare SNPs tailor their benefits to the specific needs of the groups they serve. Several of these plans cater to the needs of people with dementia and Alzheimer’s. Under one of these plans, you’ll likely receive coverage for dementia-related drugs.
To be eligible for a Medicare Special Needs Plan, you must:
- Live in a nursing home or receive regular skilled nursing care.
- Be eligible for both Medicare and Medicaid.
- Have a specific chronic condition, such as diabetes or dementia.
Some Medicare Advantage plans have expanded to add in-home long-term care benefits. Check your Medicare Advantage plan to see what’s covered, and keep in mind that the availability of specialized Medicare Advantage plans varies by location.