What Medicare Does and Doesn't Cover for Alzheimer's Care

Medicare plays a central role in supporting the medical needs of people with Alzheimer’s—but it doesn’t cover everything. The program helps pay for diagnosis, care planning, outpatient visits, and many treatments. But it does not cover custodial care or long-term residential support—services that often become necessary as the disease progresses.

Alzheimer’s affects an estimated 7.2 million Americans age 65 and over. Medicare spends nearly three times more on these patients—an average of $21,973 annually—than on those without dementia. Yet many families are unprepared for the out-of-pocket costs Medicare leaves behind. This guide breaks down what each part of Medicare (A, B, D, and Advantage) does and doesn’t cover, explains how to plan for uncovered needs, and walks through supplemental options like Medigap, Medicaid, and veterans benefits. You'll also find resources for caregivers navigating the financial and emotional challenges of long-term Alzheimer’s care and information about how a Solace advocate can help.

Understanding Alzheimer's Disease and Dementia

Alzheimer’s disease is the most common form of dementia, a broad term for a group of brain disorders that affect memory, thinking, and behavior. Other types of dementia include vascular dementia, Lewy body dementia, and frontotemporal dementia. Each presents differently, but all can lead to significant cognitive decline and growing care needs over time. Alzheimer’s accounts for 60–80% of all dementia cases.

Alzheimer’s is progressive, meaning symptoms worsen gradually. The disease is typically categorized into three stages:

• Early-stage (mild): Individuals may still live independently but experience memory lapses, trouble with familiar tasks, or changes in mood and behavior.
• Middle-stage (moderate): This stage brings increased confusion, need for supervision, and assistance with daily tasks such as managing medications or preparing meals.
• Late-stage (severe): Patients often lose the ability to communicate, recognize loved ones, or care for themselves, requiring full-time, hands-on care.

The type and intensity of care needed shifts dramatically across these stages. For example, mild symptoms may only require occasional doctor visits or medication adjustments, while late-stage disease often demands round-the-clock support—much of which is not covered by Medicare. That’s why it’s so important to understand what Medicare can and cannot provide as early as possible, especially for families trying to budget for the years ahead.

‍Medicare Coverage for Alzheimer's Diagnosis

Medicare helps cover the critical first step in Alzheimer’s care: getting an accurate diagnosis. Early detection allows for better care planning, access to treatment options, and time to prepare legally and financially.

Medicare Part B covers cognitive assessments during your Annual Wellness Visit. This is a no-cost, preventive service for all Medicare beneficiaries.

• Annual Wellness Visit: Includes a health risk assessment and cognitive evaluation.
• Cognitive assessments: Screen for memory loss or changes in thinking and reasoning.
• Follow-up testing: If issues are detected, your doctor may recommend more detailed testing.

If the initial assessment raises concerns, Medicare will also cover diagnostic tests, provided they are medically necessary and ordered by a physician:

• Brain imaging: Includes CT, MRI, or PET scans to detect brain changes such as beta-amyloid plaques.
• Neurological exams and blood tests: Used to rule out other conditions and confirm diagnosis.
• Specialist referrals: Covered under Part B, though coinsurance and deductibles apply.

In late 2023, Medicare lifted prior restrictions on amyloid PET scans, ending the one-per-lifetime rule and coverage-with-evidence-development requirements. Coverage is now determined by local Medicare contractors, allowing broader access—but some imaging providers may still require prior authorization or limit use based on clinical setting, diagnosis, or cost.

Timely and accurate diagnosis lays the foundation for effective Alzheimer’s care—and Medicare helps make that possible. But what happens after diagnosis depends on the form of care needed next.

Medicare Part A Coverage for Alzheimer's Care

Medicare Part A helps cover hospital-based and facility-level care for people with Alzheimer’s disease, but only under specific conditions. While it plays a key role in short-term medical support, it does not pay for long-term custodial care.

Inpatient hospital care is covered when a beneficiary is admitted for a qualifying medical condition.

• Coverage includes: Room and board, nursing care, medications, and other hospital services.
• Limitations: Beneficiaries pay a deductible and coinsurance after 60 days of hospitalization.
• Alzheimer’s relevance: Hospital stays often occur due to complications like infections, falls, or behavioral crises.

Skilled nursing facility (SNF) care is covered for up to 100 days following a qualifying hospital stay of at least three consecutive days.

• Covered services: Rehabilitation therapies, skilled nursing care, and some medications.
• Limitations: Coverage ends after 100 days per benefit period; daily coinsurance starts on day 21.
• Important note: Routine personal care (bathing, dressing, eating) is not covered if that’s the only care needed.

Home health care under Part A may apply after a hospital stay if the patient is homebound and needs intermittent skilled care.

• Covered services: Nursing care, speech therapy, physical therapy and occupational therapy
• Limitations: Custodial care and round-the-clock home care are not covered.

Hospice care is available for individuals with late-stage Alzheimer’s who are expected to live six months or less, if the disease follows its typical course.

• What’s included: Pain relief, symptom management, counseling, and support for both patient and family.
• Cost: Generally free aside from small copays for medications and respite care.

Part A can support major transitions and late-stage needs, but it’s not a solution for ongoing daily care—something many families are surprised to learn only after a crisis.

Medicare Part B Coverage for Alzheimer's Care

Medicare Part B covers a wide range of outpatient services that are vital to managing Alzheimer’s disease across all stages. These include doctor visits, care planning, mental health support, and certain medical supplies. While coverage is broad, costs like deductibles and coinsurance still apply.

Outpatient medical services are typically where Alzheimer’s patients and caregivers spend the most time engaging with the healthcare system.

• Covered visits: Primary care, neurologists, geriatricians, and outpatient specialists.
• Emergency room care: Covered when medically necessary, though patient cost-sharing applies.
• Outpatient hospital services: Includes lab tests, X-rays, and other diagnostic services.

Care planning services are also covered under Part B for patients diagnosed with cognitive impairment.

• Includes: Development of a care plan, referrals to community resources, and education for caregivers.
• Access: Available once a formal diagnosis is made and billed separately from a standard visit.
• Why it matters: A documented care plan helps patients and families coordinate treatment and plan ahead.

Mental health services are especially important, as depression, anxiety, and behavioral symptoms are common in Alzheimer’s patients.

• Services include: Psychiatric evaluation, individual or group therapy, and medication management.
• Limitations: Frequency caps may apply; services must be provided by Medicare-approved professionals.
• Provider types: Clinical psychologists, licensed social workers, psychiatrists, and certain nurses.

Durable Medical Equipment (DME) such as walkers, hospital beds, and mobility aids are also covered if their use in the home is deemed medically necessary.

• Examples for Alzheimer’s patients: Bed rails, patient lifts, and home oxygen in some cases.
• Requirements: Physician prescription and use of Medicare-enrolled DME suppliers.
• Costs: 20% coinsurance after deductible; upgrades or non-standard features may not be covered.

Part B helps support ongoing, day-to-day medical management—but like Part A, it stops short of covering the non-medical help most patients eventually need.

Medicare Part D Coverage for Alzheimer's Medications

Medicare Part D helps cover prescription drugs, including medications approved to treat Alzheimer's symptoms and, in some cases, slow disease progression. This coverage can significantly ease the financial burden—if the right plan is selected and requirements are met.

Commonly covered Alzheimer’s medications include:

• Cholinesterase inhibitors: Donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne).
• NMDA receptor antagonists: Memantine (Namenda).
• Anti-amyloid therapies: Leqembi (lecanemab), Aduhelm (aducanumab)—coverage varies and often requires strict documentation.
• Symptom-management drugs: Antidepressants, antipsychotics, or sleep aids when medically necessary.

However, coverage is never automatic. Medicare drug plans each have their own formularies, or lists of approved medications.

• Prior authorization: May be required, especially for newer drugs like Leqembi or high-cost therapies.
• Step therapy: Plans may require trying less expensive medications before approving others.
• Quantity limits: Can restrict how much medication a patient can get at once.

Out-of-pocket costs under Part D can add up, especially for newer treatments.

• Deductibles: Many plans have a yearly deductible.
• Copayments/coinsurance: After the deductible, beneficiaries typically pay ~25% until reaching the $2,000 out-of-pocket cap. (The so-called "donut hole" coverage gap was effectively eliminated in January, 2025.)
• Catastrophic coverage: No longer applies as of 2025, as out-of-pocket spending is capped at $2,000 for the year.

Choosing a Part D plan tailored to Alzheimer's needs—ideally with formulary coverage for relevant medications and low cost-sharing—is a crucial part of long-term planning.

Medicare Advantage (Part C) Coverage for Alzheimer’s

Medicare Advantage (Part C) plans—offered by private insurers—cover everything Original Medicare (Parts A and B) does, and often more. For Alzheimer’s patients, these plans can offer helpful supplemental benefits, but coverage details vary significantly between plans.

Basic coverage comparison with Original Medicare:

• Required coverage: All Medicare Advantage plans must provide the same Part A and B benefits as Original Medicare.
• Potential extras: Some MA plans include vision, dental, hearing, or fitness benefits.
• Network restrictions: You may need to see in-network doctors or get referrals for specialists.

Special Needs Plans (SNPs) can be particularly valuable for Alzheimer’s patients.

• D-SNPs and C-SNPs:Dual-eligible SNPs (for people with Medicare and Medicaid) and Chronic Condition SNPs (for dementia) provide enhanced coordination.
• Benefits: C-SNPs often include care planning, case managers, and expanded dementia-specific support.
• Availability: These plans are not nationwide—availability varies by ZIP code.
• Enrollment: Patients must meet specific criteria and may need to wait for a special enrollment period.

Supplemental benefits for Alzheimer’s care are becoming more common.

• Examples: Transportation to doctor’s appointments, home-delivered meals, in-home safety assessments, or limited respite care.
• Caregiver support: Some plans offer education, support groups, or limited counseling access.

Cost considerations:

• Premiums: Some plans have $0 premiums, while others charge more than Original Medicare.
• Out-of-pocket maximums: Unlike Original Medicare, MA plans have annual caps on total spending.
• Copays and deductibles: Vary widely by plan—important to review specifically for Alzheimer’s-related services.

Medicare Advantage can offer meaningful extras, but families must weigh these benefits against potential restrictions in access, coverage consistency, and long-term flexibility.

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What Medicare Does NOT Cover for Alzheimer's Care

Despite its broad medical coverage, Medicare does not pay for the types of daily help most Alzheimer's patients eventually need—especially as the disease progresses into the moderate and severe stages. These gaps in coverage can catch families off guard if they’re not planning ahead.

Custodial care, or help with activities of daily living (ADLs), is not covered by Medicare.

• Examples: Bathing, dressing, grooming, toileting, meal preparation, and supervision.
• Setting: Whether provided at home or in a facility, custodial care is considered non-medical and not eligible for Medicare reimbursement.
• Exception: If custodial services are part of a broader, medically necessary skilled care plan, some overlap may be covered—though only temporarily.

Long-term care facilities such as nursing homes, memory care units, or assisted living are generally not covered.

• After 100 days: Medicare’s skilled nursing benefit ends, even if the patient still needs care.
• Out-of-pocket burden: The average cost of memory care in the U.S. exceeds $6,000 per month.
• Misconception: Many families assume Medicare will help cover assisted living—this is almost never the case.

Adult day care services are also not covered.

• What they provide: Supervised daytime programs offering meals, activities, and health monitoring.
• Typical costs: Between $75 and $125 per day, depending on services and location.
• Alternative funding: May be available through Medicaid waivers or local aging agencies.

Home care beyond skilled nursing is another major gap.

• Uncovered services: Companionship, 24-hour monitoring, homemaker tasks, and unskilled help.
• Private pay: Families often turn to personal savings or long-term care insurance for this level of support.

These uncovered costs represent some of the most financially devastating aspects of Alzheimer’s care. Understanding what’s excluded from Medicare is just as important as knowing what’s included—especially for caregivers trying to make long-term arrangements.

Alternative Funding Sources for Non-Covered Alzheimer’s Care

When Medicare falls short—particularly for custodial and long-term care—families often need to look elsewhere for help. A mix of public programs, private insurance, and personal financial tools can help cover services that Medicare doesn’t pay for.

Medicaid is the most common funding source for long-term care in the U.S.

• Eligibility: Based on income and asset limits, which vary by state.
• What’s covered: Nursing homes, HCBS, adult day care, and memory care in some states or licensed facilities.
• Application process: Often complex and may involve spend-down strategies or asset reallocation.

Long-term care insurance is another option—if purchased early enough.

• When to buy: Ideally before cognitive symptoms emerge, while still medically eligible.
• What it covers: Varies by policy but may include home care, adult day care, assisted living, and skilled nursing.
• Limitations: Premiums can be high, and not all applicants are approved.

Veterans benefits can provide substantial support for eligible individuals.

• Aid and Attendance benefit: A pension supplement for veterans and surviving spouses needing daily help.
• Services covered: In-home care, assisted living, or nursing home costs.
• Requirements: Must meet military service, income, asset, and care need thresholds.

Other financial tools may be worth considering:

• Life insurance conversions: Some policies can be sold or converted to help pay for care.
• Reverse mortgages: Allow homeowners to tap into home equity for in-home care expenses.
• Tax benefits: Deductions for medical expenses or caregiving costs may apply.
• Community programs: Area Agencies on Aging, Alzheimer’s Associations, and nonprofits may offer grants or subsidized services.

While patchwork in nature, these funding sources can help fill the large and often unexpected financial gaps left by Medicare. In some areas, Programs of All-Inclusive Care for the Elderly (PACE) can coordinate both medical and long-term services. The key is to begin exploring these options well before care needs reach their peak.

Medicare Supplement (Medigap) Policies for Alzheimer’s Patients

Medicare Supplement Insurance—commonly called Medigap—can help pay for out-of-pocket costs left behind by Original Medicare. While Medigap doesn’t add coverage for long-term care, it can significantly reduce expenses tied to Alzheimer’s-related hospital visits, doctor care, and outpatient services.

How Medigap works with Original Medicare:

• What it covers: Coinsurance, copayments, and deductibles for Medicare-approved services.
• Plans A–N: Each standardized plan offers a different mix of benefits; some cover foreign travel emergencies or skilled nursing coinsurance.
• No prescription drug coverage: Medigap policies don’t include Part D benefits—those must be purchased separately.

Best Medigap plans for Alzheimer’s patients typically offer broad coverage and predictable costs.

• Popular choices: Plans G and N are frequently recommended for people with high medical usage.
• Why it helps: Alzheimer’s patients often have frequent provider visits, tests, or therapy—Medigap can prevent surprise bills.
• Limits: Even the most comprehensive Medigap plan won’t pay for personal care, in-home aides, or long-term facilities.

Enrollment timing matters.

• Open enrollment: The best time to buy is during the 6-month window after turning 65 and enrolling in Part B—coverage is guaranteed regardless of preexisting conditions.
• After that window: Insurers may deny coverage or charge more based on medical underwriting.
• Guaranteed issue rights: Some situations—like losing employer coverage—trigger a special right to buy without penalties.

Only people with Original Medicare—not Medicare Advantage—can buy Medigap. It's wise to compare what each Medigap plan covers and how much it costs per month. For families managing Alzheimer’s care, a strong Medigap policy can bring peace of mind—but it’s not a substitute for planning ahead.

Planning Ahead: Financial Strategies for Alzheimer’s Care

Alzheimer’s care is a long journey—often spanning many years, with evolving needs and rising costs. Medicare may cover critical pieces of medical care, but it’s rarely enough on its own. Building a financial strategy early can help families avoid reactive, high-cost decisions later on.

Creating a comprehensive care budget is the starting point.

• Estimate covered costs: Use Medicare guidelines to forecast hospital stays, outpatient visits, medications, and durable medical equipment.
• Project non-covered expenses: Include personal care, memory care, adult day programs, and respite care.
• Plan for disease progression: Costs typically rise sharply in middle and late stages, especially if residential care becomes necessary.

Work with a financial advisor who understands aging and healthcare.

• Specialization: Look for advisors experienced in elder care or certified in long-term care planning.
• Strategies: May include spend-down planning for Medicaid eligibility, or balancing long-term care insurance with liquid assets.
• Estate planning: Aligns financial tools with legal documents to protect the patient and family.

Legal planning is equally important.

• Power of Attorney (POA): Allows someone to make financial or healthcare decisions if the patient loses capacity.
• Advance directives: Outlines medical preferences for future care.
• Guardianship considerations: If POA documents are not in place, the family may need to petition for legal authority.
• Elder law attorney: Can help navigate these decisions and coordinate with public benefits planning.

Resources for financial and caregiving support are more accessible than many families realize.

• Nonprofit organizations: The Alzheimer’s Association, National Council on Aging, and local aging agencies offer tools and grants. State Health Insurance Assistance Programs (SHIPs) also provide free, one-on-one help with Medicare and long-term care planning.
• State programs: Some states offer caregiver training, respite funding, or subsidies for in-home support.
• Community services: Religious organizations, civic groups, or neighborhood networks may provide transportation or meal assistance.
• Caregiver support groups: Offer guidance, emotional support, and resource sharing.

With planning, families can stretch their resources further and avoid crisis-driven decisions that may jeopardize care or financial security. It’s not easy—but it is manageable with the right tools and support.

How Solace Advocates Can Help with Alzheimer’s Care

For families navigating the maze of dementia care, Solace Alzheimer's advocates offer a critical layer of support—especially when Medicare coverage runs thin or the system feels too complex to manage alone.

Solace advocates are Medicare-covered professionals who work directly with patients and caregivers to coordinate care, find coverage options, and ease communication with healthcare providers. For individuals with Alzheimer’s or other forms of dementia, this can make an enormous difference in both daily logistics and long-term planning.

• Coordinating appointments and follow-up care: Advocates help keep care on track across multiple providers, specialties, and settings—ensuring nothing gets lost in the shuffle.
• Explaining Medicare benefits and plan choices: From Part D drug coverage to SNP eligibility, Solace advocates help families understand what’s covered, what’s not, and what to consider next.
• Supporting caregivers: Advocates can recommend local respite options, prepare for transitions into memory care, and connect families to financial or legal resources.
• Virtually attending doctor's visits: When permitted, Solace advocates can join doctor appointments by phone or video to ask questions, take notes, and help the patient follow through on care plans.

Because Solace advocates are covered by Medicare, there’s no cost to the patient for using their services. For many families, this becomes a vital lifeline—both financially and emotionally—as Alzheimer’s progresses.

FAQ: Frequently Asked Questions About Medicare Coverage for Alzheimer's Care

Does Medicare cover memory care facilities?

No, Medicare does not cover the cost of memory care facilities. These specialized residential communities provide 24/7 supervision and assistance for people with Alzheimer’s or other forms of dementia—but they are considered custodial care. While Medicare may pay for certain medical services received within a memory care setting (like physician visits or physical therapy), it does not pay for room, board, or personal care services. Families typically rely on private funds, Medicaid (if eligible), or long-term care insurance to cover these costs.

Will Medicare pay for in-home caregivers for Alzheimer's patients?

Medicare only covers in-home care when it is considered medically necessary and part of a skilled care plan—such as intermittent nursing, physical therapy, or speech-language services ordered by a doctor. It does not cover non-medical home care services like help with bathing, dressing, toileting, or meal preparation. These services, often provided by personal care aides or homemakers, must be paid for out-of-pocket or through other funding sources like Medicaid, VA benefits, or private insurance.

How does Medicare coverage change as Alzheimer's progresses?

Medicare continues to cover medically necessary services as Alzheimer’s progresses—such as doctor visits, medications, cognitive assessments, and durable medical equipment. In late-stage disease, hospice care becomes available for patients with a life expectancy of six months or less. However, as the disease advances, families increasingly rely on services that Medicare does not cover: full-time supervision, long-term facility care, and 24/7 in-home help. At that point, alternative funding sources like Medicaid or long-term care insurance become more critical.

Does Medicare cover the new Alzheimer's drugs like Leqembi?

Yes, Medicare does cover Leqembi (lecanemab) and other anti-amyloid monoclonal antibody treatments—but only under certain conditions. Coverage requires that the patient has a confirmed diagnosis of mild cognitive impairment or early Alzheimer’s and is enrolled in a qualifying registry that tracks treatment outcomes. The drug must also be prescribed by a physician who participates in Medicare. Even when covered, patients may still face high out-of-pocket costs depending on their Part B deductible and coinsurance, or their Medicare Advantage plan’s policies.

What happens when Medicare's 100 days of skilled nursing coverage ends?

After the 100-day limit in a skilled nursing facility (SNF), Medicare stops paying—regardless of whether the patient still needs care. Families are then responsible for the full cost of continued stay, unless the patient qualifies for Medicaid or can transition to a less intensive (and often less expensive) care setting. This coverage cap is one of the most significant limitations in Medicare’s support for long-term Alzheimer’s care and is a common source of surprise and stress for caregivers.

Can someone with early-onset Alzheimer's qualify for Medicare before age 65?

Yes. People diagnosed with early-onset Alzheimer’s can become eligible for Medicare under age 65 if they qualify for Social Security Disability Insurance (SSDI). After a qualifying diagnosis and approval for SSDI, there is a 24-month waiting period before Medicare benefits begin. In 2010, legislation was passed specifically to fast-track disability determinations for individuals with early-onset Alzheimer’s, recognizing the unique and urgent care needs of this group.

Will Medicare cover respite care for Alzheimer's caregivers?

Medicare covers limited respite care only through the hospice benefit. If an Alzheimer’s patient is enrolled in Medicare-covered hospice with a prognosis of six months or less, the program may pay for up to five consecutive days of inpatient respite care at a Medicare-approved facility. Outside of hospice, Medicare does not pay for respite services—families must look to Medicaid, veteran benefits, or nonprofit support programs to access these breaks in caregiving.

‍This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

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