Does Medicare Pay for Dementia Care?

An estimated 65 million Americans live with Alzheimer’s disease, the majority of which are over 65 and eligible for Medicare services. However, Medicare only covers some of the services that these individuals will need as the disease progresses. This discrepancy creates a gap between the care people need and the care they are receiving under their coverage. 

These concerns are part of a more extensive public policy discussion that impacts dementia care across the country, including right here in San Antonio. Bella Groves aims to be a part of this discussion as we advocate for broader dementia education, support, and coverage.  

What Does Medicare Cover? 

Medicare benefits impact a person differently throughout each stage of Alzheimer’s disease. We’re going to look at what each stage entails and what is—and isn’t—covered in each. 

Early-Stage Alzheimer’s Disease 

The earlier stage of Alzheimer’s is where an individual can function independently and may have not even received an official diagnosis. They can still work, drive, and take care of themselves, but may experience some lapses in memory, difficulty concentrating, or trouble finding the right word. 

Diagnosing Alzheimer’s disease requires a visit to the doctor, as well as other tests like an MRI and CAT scan. Since these tests are diagnostic, they are 80% covered by Medicare Part B. In addition, any medications prescribed to help slow the progress of the disease may be partially covered through Medicare Part D.

Middle-Stage Alzheimer’s Disease 

As the disease progresses into the middle stage, symptoms become more evident and frequent, and the individual may require some additional attention or support. This stage can last for several years and is usually when family members start to explore options regarding more dedicated care. 

In some states, Medicare benefits cover specialized training for family caregivers to better understand how to manage challenging behaviors in their loved ones. Unfortunately, Texas is not one of those states, and it is part of our mission at Bella Groves to change that. Education and training are vital to dementia care. Through our dementia resources, we strive to be a trusted voice that educates individuals and families on dementia and memory loss. 

According to the Centers for Medicare & Medicaid Services (CMS), in 2021, about 730 plans are expected to provide about three million Medicare Advantage enrollees with supplemental benefits, such as short-term care services, meal delivery, in-home supportive services, and support for caregivers.

Late-Stage Alzheimer’s Disease 

In the late stages of Alzheimer’s, individuals typically require round-the-clock care and attention. Since most family members do not have the training or time to provide this, families often look for long-term dementia care communities. These communities provide professional care, daily engagement, meals, housekeeping, and other health and wellness services. 

Once again, education and training play a vital role in dementia care. Individuals and families need to ensure they are choosing a community and team with the proper knowledge, resources, and commitment to providing quality dementia care. Diana Martinez, President/CEO of the Texas Assisted Living Association (TALA), shared, 

“[Our organization] worked on a piece of legislation last legislative session that would ensure Alzheimer’s Certified communities continue to be able to distinguish themselves from [Assisted Living Communities] that are not Alzheimer’s Certified. TALA believes it is important for families seeking a place for their loved ones to ask questions about what it means to be Alzheimer’s Certified and the type of care all communities provide for individuals who need dementia care.”

The late stage of Alzheimer’s disease is when the gap in Medicare benefits becomes more glaring. While Medicare covers hospital stays up to 60 days, stays at skilled nursing facilities following a hospital stay, and hospice care, it does not cover long-term dementia care, which is often the most beneficial type of environment for those in the late stage of Alzheimer’s. 

Addressing the Gaps

Despite the undeniable benefits of Medicare, it does have its shortcomings, including the lack of dementia care coverage. This is a challenge that has been at the forefront of dementia advocacy. At Bella Groves, we firmly believe in providing education and resources about dementia, and we hope that one day, we can guarantee access to dementia care for every person and family who needs it. In the meantime, there are several other ways to cover the cost of dementia care, including long-term insurance, V.A. benefits, and others.

At Bella Groves, we will offer dementia care and resources to our local community of San Antonio and continue to advocate for dementia inclusion, friendliness, care access, and destigmatization. To discover more about our pricing structure at Bella Groves, visit our website.