Does Medicare cover dementia care?

What dementia care does Medicare cover?

Medicare Part B covers a separate visit with a health care provider to fully review your cognitive function, establish or confirm a diagnosis like dementia or Alzheimer's disease, and develop a care plan. Cognitive assessments check for problems with mental abilities, including memory and decision-making. During the assessment, your provider may:

• Perform an exam, talk with you about your medical history and review your medications
• Identify your social supports, including care that your usual caregiver can provide
• Create a care plan to help address and manage your symptoms
• Help you develop or update your advance care plan
• Refer you to a specialist, if needed
• Help you understand community resources, like rehabilitation services, adult day health programs and support groups

How does Medicare check for signs of dementia?

At your yearly "Wellness" visit, covered once every 12 months, your provider performs a cognitive assessment to look for signs of dementia, including Alzheimer's disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances and making decisions about everyday life. If your provider thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety or delirium.

When you have an assessment, you can bring someone with you, like a spouse, friend or caregiver, to help listen to information and answer questions.

What do I pay for dementia care with Medicare?

After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for a cognitive assessment and care plan visit. You pay nothing for the yearly "Wellness" visit if your provider accepts assignment, but you may pay coinsurance and the Part B deductible if your provider performs additional tests or services during the same visit that this preventive benefit doesn't cover.

Advance care planning costs nothing if your provider accepts assignment and the planning is part of your "Welcome to Medicare" or yearly "Wellness" visit; if you get it as part of other medical treatment, the Part B deductible and coinsurance apply. See how Medicare covers advance care planning.

Does Medicare help caregivers of people with dementia?

Yes, in some ways. Medicare Part B covers caregiver training when a provider determines the training is appropriate for the patient's treatment plan, and the caregiver can get the sessions without the patient present.

Some people living with dementia, and their unpaid caregivers, may be able to get additional support through the Guiding an Improved Dementia Experience (GUIDE) Model, a pilot program. CMS describes GUIDE as a voluntary, nationwide model that began on July 1, 2024, and will run for 8 years. GUIDE services come through dementia care programs that participating Medicare providers set up, and include care navigation, 24/7 access to a support line, caregiver training and education, respite services up to a yearly limit, and connections to community resources. Ask your provider whether they participate.

Does Medicare pay for long-term care for dementia?

No. Medicare doesn't pay for long-term care, also called custodial care, which includes medical and non-medical care for people with a chronic illness or disability. Most long-term care helps with basic personal tasks of everyday life, such as dressing, bathing and using the bathroom, and it also includes home-delivered meals, adult day health care and transportation. Medicare and most health insurance, including Medigap, don't pay for long-term care services, including care in a nursing home or in the community.

You may be eligible for long-term care through Medicaid if you meet your state's requirements, or you can choose to buy private long-term care insurance. Long-term care is different from skilled nursing facility care; see what Medicare pays for nursing homes.

Does Medicare Advantage change dementia coverage?

Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers, and plans may also offer extra benefits; rules and costs vary by plan. A Medicare Advantage Plan may require you to use providers in its network and to get approval (prior authorization) before it covers certain services.