Original Medicare covers some care for people with Alzheimer’s disease, dementia or memory loss. It does not cover long-term custodial memory care. This includes room and board or ongoing help with daily tasks. Medicare Advantage (Part C) plans cover the Part A and Part B services that Original Medicare covers. They can also include added benefits that vary by plan.
If you care for someone with memory loss, understanding their coverage can help you plan for their care.
What do I need to know about Medicare coverage for memory care?
- Original Medicare covers some medical care for memory loss. This can include doctor visits, tests and other health care.
- Original Medicare does not cover long-term custodial memory care. This includes room and board or ongoing help with daily tasks.
- Medicare Advantage plans cover Original Medicare services and can include added benefits. Check your plan for coverage, costs and benefits.
What is memory care?
Memory care is long-term care for people with Alzheimer’s disease, dementia or memory loss.
Memory care can include health care and help with daily activities. It can also include supervision, structured daily routines and help managing medicines. When memory care includes help with daily tasks, Medicare calls that custodial care. This can include bathing, dressing and eating.
Original Medicare does not cover custodial care when this is the only care a person needs.
What common memory care services does Original Medicare cover?
Original Medicare may cover medical care for people with memory loss. This can include doctor visits, tests, short-term skilled nursing care, hospice and home health care. Coverage depends on the service and whether you meet Medicare’s coverage requirements.
Doctor visits and diagnostic services
Medicare Part B covers doctor visits and certain tests used to diagnose or treat memory problems. Part B also covers a separate cognitive assessment. This visit can help check memory and thinking. It can also help create a care plan. The care plan can include treatment, specialist referrals and caregiver support.
Medicare Part B may cover CT scans, MRIs or PET scans when a health care provider orders them because they are medically necessary.
Learn more about Medicare coverage for PET, MRI and CT scans
Prescription drug coverage
Original Medicare does not include prescription drug coverage.
A separate Part D plan plan may cover drugs used to treat Alzheimer’s disease or dementia based on its drug list (formulary). Most Medicare Advantage plans include Part D drug coverage.
Medicare Part B may cover certain FDA-approved treatments for early Alzheimer’s disease.
Learn more about Medicare Part B drug coverage for early Alzheimer’s disease treatments
Short-term skilled nursing facility care
A person with dementia may need short-term skilled nursing facility care after a hospital stay.
Medicare Part A may cover this care when the person meets Medicare’s coverage requirements.
Skilled care can include short-term nursing care, physical therapy, occupational therapy and speech-language therapy.
Learn more about Medicare coverage for skilled nursing facilities
Hospice care
People with advanced Alzheimer’s disease or dementia may need hospice care near the end of life.
Hospice care is care for someone with an illness that cannot be cured. Hospice care can include nursing care, medicine for pain and symptoms, medical equipment and support for caregivers.
Medicare Part A may cover hospice care when the person meets Medicare’s requirements.
Learn more about Medicare coverage for hospice
Home health services
Home health care provides covered services in a person’s home. Medicare may cover some home health care when you meet coverage requirements.
Covered care can include part-time skilled nursing and therapy. It can also include some home health aide services. For example, a home health aide may help with bathing or grooming.
Medicare does not cover 24-hour care at home or ongoing personal care when that is the only care needed.
Learn more about Medicare coverage for home health care
Do Medicare Advantage plans cover care for people with memory-related conditions?
Yes. Medicare Advantage plans cover the Part A and Part B services that Original Medicare covers for people with Alzheimer’s disease, dementia or memory loss. Some plans also offer added support, such as care coordination or caregiver support. Benefits, costs and provider networks vary by plan.
Check your plan documents to see what your plan covers.
If you are an Aetna® Medicare member, log in to review your plan coverage.
What common memory care services does Original Medicare not cover?
Original Medicare does not cover long-term custodial care when you only need help with daily tasks.
This includes:
- Room and board in a memory care or assisted living facility
- Ongoing help with daily activities, such as bathing, dressing or eating
- 24-hour personal care or supervision when skilled medical care is not needed
How can I check my Medicare coverage for memory care services?
Start by finding out what type of care the person needs. Then:
- Check whether Medicare covers the service the person needs, such as skilled nursing, home health care or hospice. Review the coverage requirements at Medicare.gov.
- If you have Medicare Advantage, review your plan documents for your coverage and costs.
- If you are an Aetna® Medicare member, log in to review your coverage and benefits.
- Contact Aetna Medicare Member Services if you still have questions.
Common memory care questions
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No. Original Medicare does not cover the long-term cost of living in a memory care facility, including room and board or custodial care.
Original Medicare may still cover some medical care you receive while living there. -
Yes, Medicare can cover certain drugs used to treat Alzheimer’s disease. Coverage depends on the drug and whether Part B or a Part D plan covers it.
If you are an Aetna® Medicare member, review your drug list. -
Yes. Original Medicare may cover medical care for people with dementia.
It does not cover long-term custodial care. -
No, not for every service. For example, Part B covers a cognitive assessment. This can help check for dementia or Alzheimer’s disease.
Some treatments or services require a confirmed diagnosis or other medical records before Medicare covers them.
