How Medicare Covers Dementia Care
Short answer
Medicare can cover medically necessary dementia evaluation and treatment, but it does not provide a general long-term custodial-care benefit solely because a person has dementia.
Coverage
Covered services can include physician evaluation, cognitive assessment and care planning, diagnostic testing, eligible therapy, hospital care, drugs and qualifying home health.
Not Automatic
Supervision, help with activities of daily living, assisted-living room and board and other custodial services are generally not covered by Original Medicare when custodial care is the only need.
Costs And Ma
Medical services follow their normal Medicare cost rules. Any Medicare Advantage supplemental benefits are conditional and plan-specific.
Practical Example
Medicare may cover a medically necessary physician assessment for worsening cognition, but that does not mean Medicare pays indefinitely for residential custodial supervision.
Questions to verify
- What medical service is being provided?
- Is the need skilled medical care or custodial assistance?
- Are any plan supplemental benefits available this year?