Key takeaways
- Original Medicare (parts A and B) covers various dementia-related services, including screening tests, home healthcare, prescription medications, and hospice care.
- To qualify for Medicare-covered home health services, a person with dementia must be unable to leave their home without assistance or their condition must make it unsafe for them to leave.
- While Medicare doesn’t cover 24-hour in-home care, it does cover part-time home health services, such as wound care, medication assistance, physical therapy, and occupational therapy, for up to 35 hours per week.
Original Medicare covers various services related to dementia treatment and care. These services include screening tests, home healthcare, prescription medications, and hospice care.
While Medicare doesn’t cover 24-hour home care, it covers part-time home health services for people who can’t leave their homes. Original Medicare covers up to 35 hours per week of home health services.
In the early stages of dementia, home healthcare may offer sufficient support. As the condition progresses, a person may need more routine care.
To qualify for home health services under Medicare, a person with dementia must be unable to leave their home. This means:
- They have difficulty leaving home without the help of an assistive device or caregiver.
- Their condition makes leaving home potentially unsafe or ill-advised.
- They typically don’t leave home due to the effort it requires.
Before receiving home health services, a healthcare professional usually conducts an in-person assessment to certify that they meet the eligibility requirements.
If a healthcare professional deems home healthcare medically necessary, a Medicare-approved agency must provide the care. Further, the agency must have a plan of care that a doctor updates and reviews regularly.
Medicare doesn’t cover home healthcare if a person with dementia requires full-time care.
Medicare Part A and Part B cover home health services. The types of dementia home care services that Medicare covers can include:
- wound care help
- assistance with medications
- physical therapy
- occupational therapy
Medicare doesn’t cover homemaker services or meal deliveries. Homemaker services include activities like shopping and cooking.
As dementia progresses, a person may need more intensive treatment and even 24/7 care. Medicare Part A can cover the first 100 days of a person’s stay in a skilled nursing facility (SNF).
If a person with dementia has a qualifying hospital stay, and their healthcare team decides they need routine nursing care, they may get assistance transferring to an SNF. A person pays $0 for the first 20 days. From days 21 to 100, they pay $209.50 per day. After that, they pay the full cost.
In 2024, the Centers for Medicare & Medicaid Services (CMS) launched a program called the Guiding an Improved Dementia Experience (GUIDE) Model. This voluntary program aims to help support people with dementia and their unpaid caregivers by connecting them with various services, training programs, and other resources.
Learn more about the GUIDE Model.