Page Reviewed / Updated - February 27, 2020
Medicare is the primary medical care insurance for a large number of seniors. Many are shocked to discover that Original Medicare (Medicare Part A & Part B), also called Traditional Medicare, does not cover costs for most types of long term care, including Alzheimer's and dementia care. When it does pay, it is only in a very limited capacity. While Traditional Medicare is not a long term care solution, there are benefits for seniors with recoverable conditions on a short term basis. Also, as mentioned previously, some Medicare Advantage Plans (Medicare Part C) now offer some home and community based long term care benefits under specific circumstances.
Skilled Nursing Facilities
Medicare will pay for 100% of the cost of care up to 20 days at a skilled nursing facility and approximately 80% of the cost up to 80 more days. The care must be for recovery following an inpatient hospital stay.
Assisted Living Communities
Medicare does not cover any cost of assisted living. It will pay for most medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care (personal care) or the room and board cost of assisted living. Some Medicare Advantage plans may pay for personal care assistance for persons residing in assisted living or memory care, but will not contribute towards the cost of room and board.
In Home Care
Medicare will cover skilled nursing care in the home for a limited time period, but not non-medical care. Care must be prescribed by a doctor and needed part-time only. The senior must be “confined”, meaning they are unable to leave the home without the assistance of another person. This is formally referred to as "homebound". However, non-medical, in-home personal care assistance may be available through some Medicare Advantage plans.
Adult Day Care
Original Medicare does not pay for adult day care services, but some Medicare Advantage plans may cover the cost.
Alzheimer's / Dementia Care
Unfortunately, most care associated with Alzheimer's is considered personal care, and therefore, not paid for by Medicare. That said, some Medicare Advantage plans may cover the cost of personal care assistance. Medical care associated with Alzheimer's is covered by Original Medicare and Medicare Advantage. For very late stage Alzheimer's patients, there is a hospice benefit that may be applicable to Medicare beneficiaries. Read more about paying for Alzheimer's care.
Medicare offers hospice coverage for terminally ill individuals whom doctors determine have less than 6 months to live. While Medicare hospice does not typically pay for room and board, it does cover medical expenses, prescription drugs, and homemaker services, which are typically not paid for by Medicare. Although in most cases hospice care is given in-home, it’s possible for one to opt for inpatient care.