Whether you're in the early stages of a memory care diagnosis and looking at long-term care options for yourself or you're a caregiver trying to navigate coverage for a loved one, the process can be complex and overwhelming. It's always important to work with care teams and your insurance company to understand what options are covered, as individual circumstances can change those answers.
For many older adults facing memory care diagnoses, the questions often center on whether Medicare provides coverage. We've gathered some facts below to help you understand the basics of memory care and relevant Medicare coverage. If your loved one is a resident at Bethesda Gardens in Loveland or you're considering our assisted living community, reach out to our staff for more information.
Medicare Part B covers medically necessary doctor visits that may be relevant to providing care for someone with a memory diagnosis such as dementia or Alzheimer's. That includes planning services for individuals who have recently received one of these types of diagnoses. This planning provides an option for caregivers and the individual to learn about treatment options and how to support the highest possible quality of life as the disease progresses.
Medicare Part A covers medically necessary inpatient stays in qualified hospitals and other locations. This does not include long-term care offered in a nursing home or an assisted living community such as Bethesda Gardens Loveland.
Medicare plans may cover some home services for those with dementia or other cognitive disorders. That includes home safety evaluations and medically necessary home health services. Medicare pays for up to 35 hours of home health care a week for individuals who are certified as "homebound." This means they are unable to seek medically necessary services outside of their home. However, this doesn't cover oversight or simple help with certain types of living activities that those with memory care disorders may require.
Medicare Part D, which is an optional prescription drug benefit, covers some prescription medications that may be used to treat memory care symptoms or delay the onset of certain symptoms.
Some specialized Medicare Part C plans are also available to assist with the costs of memory care. These are known as SNPs, or Special Needs Plans. Reach out to a Medicare benefits coordinator to find out what options you have and what type of coverage might be best.
Individuals that need more care than Medicare might cover may want to look into additional options. Medicaid, for example, covers additional in-home care if the person would require nursing home care without those services. It also covers adult daycare programs, which may be an option that allows caregivers to work during the day or attend to other obligations while retaining primary care of a loved one with dementia or Alzheimer's.
Individuals that want to invest in memory care for themselves or a loved one may have to think outside of the box as far as coverage goes. Here are some common options people consider to bridge the gap in what Medicare and other insurance providers may cover:
Covering memory care can be expensive. One way to balance the financial scales is to find ways to save on other lifestyle considerations. For example, if you choose memory care in a community, you also get a home, meals, plenty of activities and a wide range of other services. Having all those services and opportunities in a safe, vibrant location where you live may actually make memory care and your lifestyle more affordable than it might be in other situations. Bethesda Gardens is happy to help you understand the financial options for memory care for yourself or a loved one.