Does Medicare Cover Home Health Care For Dementia?

Dementia is an irreversible progressive condition that leads to significant memory and thinking skill loss. Over time, people living with dementia require increasing help with daily tasks like dressing, hygiene and meal prep; caring for someone living with dementia is often physically, emotionally and financially demanding for family caregivers who may feel overwhelmed by caregiving responsibilities. Individuals living with dementia may benefit from professional home health care services; but does Medicare cover such care for dementia patients?

Answering that question depends on both the service you need and your Medicare plan. Medicare Advantage plans and Medicare Part C plans (Medicare Advantage Plans with Chronic Care Management Services) generally cover some type of home health care for people living with dementia; it’s important to make an effort to understand all details involved.

Medicare Part A covers hospital inpatient stays and some home health care; Medicare Part B covers doctor visits and some outpatient therapy services like physical and occupational therapy; while Medicare Part D provides prescription drug coverage. Some dementia patients may need medications like cholinesterase inhibitors, N-methyl-D-aspartate receptor antagonists, and antidepressants; depending on your Medicare Advantage plan or Medigap policy you may also get coverage for depression screening during annual wellness visits and cognitive function assessments with your physician’s office.

If your doctor determines that you require daily skilled nursing care and cannot leave home safely, Medicare Part A should cover most costs associated with staying at a Skilled Nursing Facility (SNF). In addition to meal and supply costs, Part A may cover up to 20 days of Medicare Part B coinsurance payments.

Home health agencies can offer various dementia-related home healthcare services, from skilled nursing and therapy, to physical therapists helping improve motor skills and exercise programs to promote mental wellbeing; occupational therapists working on coping strategies and routines designed to promote independence; speech therapists helping address common speech-communication disorders like aphasia.

Home health agencies also provide caregiver support and respite for loved ones living with dementia, helping reduce caregiver stress while improving overall quality of life. Furthermore, these agencies may offer education or training on how to better care for patients living with dementia.

Medicare covers many aspects of dementia care, but there may be gaps. Other government-funded programs, like Medicaid, may help bridge those gaps. Medicare beneficiaries can also use private long-term care policies known as Medigap policies to cover long-term care services like memory care in assisted living facilities.