If you or someone you love has been diagnosed with dementia, you’re likely facing a whirlwind of emotions — confusion, concern, and a lot of questions. One of the biggest questions people tend to have is, “How am I going to pay for this?” Dementia care can be expensive, especially as the disease progresses and needs become more intense. Naturally, many people turn to Medicare, wondering just how much help they can get through this federal health insurance program.

The answer isn’t exactly straightforward. Medicare does cover certain aspects of dementia care, but it doesn’t cover everything — and knowing what’s included (and what isn’t) can make a big difference in your planning. In this guide, we’ll walk through what Medicare covers when it comes to dementia, where the gaps are, and how you can fill in those gaps with other options.

Let’s dive in and unpack all of it in plain English — no confusing jargon, no assumptions, just the facts that matter to families facing the reality of dementia care.

What Dementia Care Does Medicare Cover?

Medicare provides coverage for many healthcare services that people with dementia may need. However, it’s important to understand that Medicare is primarily designed to cover medical care, not long-term custodial care. Here’s a breakdown of what Medicare covers and what it does not:

Type of Care	Covered by Medicare?	Details
Doctor Visits	Yes	Medicare Part B covers medically necessary outpatient visits.
Diagnosis and Cognitive Assessments	Yes	Medicare covers an initial cognitive assessment and further evaluations.
Hospital Stays	Yes	Medicare Part A covers inpatient hospital stays.
Skilled Nursing Facility Care	Limited	Covered for a short time after hospitalization (up to 100 days).
Prescription Drugs	Yes (with Part D)	Medicare Part D helps pay for medications related to dementia.
Home Health Care	Limited	Covered if ordered by a doctor and the person is homebound.
Hospice Care	Yes	Covered if the person has a terminal illness and stops curative treatment.
Long-Term Custodial Care	No	Not covered; includes help with bathing, dressing, eating, etc.
Assisted Living/Memory Care Facility	No	Not covered by Medicare.

As you can see, Medicare handles a fair bit of medical care related to dementia, especially early on or during hospitalizations. But it stops short of paying for long-term help with daily tasks — and that’s where families often feel the financial pinch.

Different Types of Dementia Care

Now that we know what Medicare does and doesn’t cover, let’s walk through the kinds of care someone with dementia might need throughout the course of their illness. Understanding these types of care can help clarify when Medicare can step in — and when you’ll need to look elsewhere for help.

Diagnostic and Routine Medical Care

This includes:

• Primary care visits
• Neurologist consultations
• Brain scans (like MRIs or CTs)
• Bloodwork and lab tests
• Cognitive assessments

Medicare Part B generally covers these services. Early diagnosis is critical in dementia care, and Medicare supports that with coverage for an Annual Wellness Visit, which includes cognitive evaluation.

Prescription Medications

While Medicare Part A and B don’t cover outpatient prescription drugs, Medicare Part D — or a Medicare Advantage plan that includes drug coverage — can help with dementia medications. These may include:

• Cholinesterase inhibitors (like Aricept)
• NMDA receptor antagonists (like Namenda)
• Antidepressants or antipsychotics

Keep in mind: Part D plans vary, so the specific medications covered and the out-of-pocket costs can differ based on the plan.

Short-Term Skilled Nursing Care

If a person with dementia is hospitalized — say, for a fall, stroke, or infection — and then discharged to a skilled nursing facility, Medicare Part A may cover up to 100 days of rehab care. However, this coverage has limits:

• The person must have a qualifying hospital stay (3 days inpatient).
• Care must be medically necessary.
• Coverage starts strong but drops off (only 100% for the first 20 days, then co-pays kick in).

It’s not designed to be a long-term solution, but it can offer short-term help during recovery.

Home Health Care

Medicare will cover home health services if certain conditions are met:

• The person must be homebound.
• A doctor must certify the need.
• Services must be intermittent and medically necessary (like nursing care, physical therapy, or speech therapy).

What’s not covered: help with daily activities like bathing, cooking, or dressing — unless it’s part of the intermittent medical care plan.

Hospice

Once a person with dementia is diagnosed with a life expectancy of six months or less (if the disease follows its normal course), they may be eligible for hospice care. Medicare covers hospice under Part A, including:

• Pain and symptom management
• Palliative nursing and physician care
• Spiritual and grief support
• Limited homemaker services

This type of care can be delivered at home, in a hospice facility, or sometimes in a nursing home.

Custodial and Long-Term Care

This is where Medicare drops off significantly. If your loved one needs ongoing help with daily living — bathing, eating, using the toilet, or simply staying safe due to memory issues — Medicare does not cover it.

This type of care is known as custodial care, and it’s often delivered in:

• Assisted living facilities
• Memory care units
• Private-duty home care

Families often pay for this out-of-pocket or use other forms of insurance (like long-term care insurance, Medicaid, or VA benefits, if eligible).

FAQs

Does Medicare pay for memory care facilities?
No, Medicare does not cover the cost of room and board at memory care or assisted living facilities. However, if the person is receiving skilled medical services at the facility, Medicare might cover some of those medical costs — but not the housing itself.

Can I get help from Medicaid for dementia care?
Yes, if the person meets financial eligibility requirements. Medicaid often pays for long-term custodial care, including nursing homes and sometimes home-based support. Many people with dementia eventually qualify for Medicaid after spending down their assets.

Is there a Medicare Advantage plan that covers more dementia care?
Some Medicare Advantage (Part C) plans may offer extra benefits, such as caregiver support, adult day care, or in-home services. These vary widely by plan and location, so it’s worth exploring if such plans are available in your area.

Does Medicare pay for adult day care for dementia patients?
Traditional Medicare does not pay for adult day care services. Some Medicare Advantage plans or Medicaid programs might offer partial coverage, depending on the state.

What are some other ways to pay for dementia care besides Medicare?
Besides Medicaid and Medicare Advantage, families often rely on:

• Long-term care insurance
• Veterans benefits (Aid & Attendance)
• State and local programs
• Private pay (personal savings or assets)
• Nonprofits or dementia support organizations that offer financial aid

Can Medicare help caregivers of dementia patients?
Medicare itself doesn’t provide caregiver stipends, but it might cover respite care under hospice benefits or certain services under a Medicare Advantage plan. Caregivers can also explore support through local Area Agencies on Aging or state-funded caregiver assistance programs.

Conclusion

Dealing with dementia is hard enough without having to navigate a confusing health insurance system. Unfortunately, Medicare only goes so far when it comes to dementia care. It’s excellent for diagnosing the condition, covering hospital stays, managing medications, and even providing hospice services — but when it comes to the day-to-day support that many people with dementia eventually need, Medicare doesn’t offer much help.

That said, understanding what’s available can help families plan smarter. Pairing Medicare with Medicaid, long-term care insurance, or veterans benefits can create a more complete safety net. It also helps to be proactive: look into resources early, talk to a financial advisor, and explore what support services are available in your state or region.

No one should have to face dementia care alone or uninformed. With the right information — and some forward-thinking planning — it’s possible to create a care plan that meets your loved one’s needs without causing unnecessary financial stress.