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Does Medicare Cover Home Health Care for Dementia Patients?

By Lan Pham, Miriam Dorisca
The various forms of dementia can bring increased medical costs into your life. Read on for some important details about Medicare and dementia.

Dementia is not a specific disease but a general term for the impaired ability to remember, think, or make decisions that interferes with everyday activities, according to the Centers for Disease Control and Prevention (CDC). The Alzheimer’s Association reports that approximately 6.2 million people in the United States are currently living with some form of dementia, and Medicare can be a financial resource for those who have been diagnosed.

When It Comes to Dementia, What Does Medicare Cover?

Medicare does pay a portion of medical expenses for dementia patients, but there are limitations. 

Prescription Drug Coverage

The drugs prescribed to treat the symptoms of dementia can be costly, according to the National Institute on Aging. While Medicare Part D will typically cover the cost of some medicines commonly prescribed for dementia, the Alzheimer’s Association notes that each Medicare Part D plan will offer specific types of coverage. In order to get the most out of Medicare Part D, the Association recommends that you:

  • Determine which plans will pay for all or most of the drugs you currently take
  • Make sure that the medications you currently take are on your chosen plan’s formulary
  • Ensure that the specific doses of your medications are covered by your chosen plan
  • Review plan details for any limitations on medications for Alzheimer’s disease or “prior approval” requirements
  • Determine which plans require you to try a cheaper, similar drug before paying for your preferred medications
  • Make sure that you understand any limits on the number of pills that a prescription may cover over a specific period of time, also known as a “quantity limit”
  • Compare final costs of each potential plan—including not only the monthly premium, but also the deductible, copays, and coinsurance costs
  • Ensure that your local pharmacy or mail-order prescription service is included in your chosen plan’s pharmacy network 

Coverage During All Stages of Dementia

According to the Centers for Medicare and Medicaid Services, Medicare will pay for some services that may be needed at all stages of dementia. These services include:

  • Cognitive assessments
  • Home safety evaluations
  • Planning for care
  • Hospital stays

Medicare will also cover up to 35 hours a week of home health care for those that are certified as “homebound”. 

Coverage During the Later Stages of Dementia

According to the Centers for Medicare and Medicaid Services, Medicare will generally only cover the first 100 days of a patient’s stay in a nursing home. Additionally, Medicare will cover hospice care for those determined to have less than 6 months to live. This hospice care includes the following:

  • Physician care
  • Nursing care
  • Personal care
  • Prescription medications
  • Counseling for both the patient and their family

Medigap

Those using Original Medicare (Parts A and B) can also elect to add Medigap coverage, also known as Medicare Supplement. 

Medigap policies are sold by private insurers. For a monthly premium, a Medigap policy will help bridge the coverage gaps in Original Medicare by offering coverage for copayments, coinsurance, and deductibles. Consult the official U.S. government website for Medicare to compare the policies available in your area.  

Get started now. 

Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.