Dementia starts with custodial care. This routine personal care does not really require the skills of trained medical staff. Then there is intermediate care which is a step beyond that and this is the time when medical care becomes necessary, although it may not be constant. In the case of skilled care, the person with dementia is in need of constant medical care in order to maintain quality life.

dementia-medicare-coverageSo where does Medicare come in? For most, Medicare offers financial provision that allows elderly dementia patients to receive their needed care. There are several care options available for these patients depending on the level of care they need. If you are considering getting a Medicare for your loved one with dementia, knowing its scopes and limitations will help you maximize the benefits that you can get from your Medicare.

Caring for a person who is suffering from dementia can be both rewarding and challenging at the same time. Although there are many who believe that that caregiving proves should be done alone, this is not true. In fact, there are several options to choose from that can assist with the care and housing needs of the person. And one of the best there is Medicare. But what does it exactly covers in case of dementia?

Medical care

The majority of medical costs in treating people with dementia are covered by Medicare. For the most part of it, any ongoing medical care to diagnose and treat dementia is covered by Medicare (Medicare Part B). This includes visits to hospitals and specialists, speech and occupational therapy, lab tests, outpatient counselling services, and home health care. Medicare pays up to 80% of these costs and the patient will only be responsible for paying the remaining 20%.

Long-term custodial care

Although Medicare does not really cover long-term custodial care, which may include nursing home care, adult daycare, and the cost of assisted living facilities; it pays for some shorter-term nursing home care. This however, may only be up to 100 days after a 3-day inpatient hospital stay.


In the final stages of dementia, Medicare covers almost all aspects of hospice care such as nursing care, doctor services, medical equipment and supplies, drugs, homemaker services, physical and occupational therapy, respite care, and counseling. In order to qualify, a certification from a doctor stating that the patient has six months or less to live is needed.

Other insurance

If you do not have a Medicare supplemental insurance policy, it’s time to consider having one. This plan can help you pay for the things that are not covered by Medicare such as coinsurance, deductibles, and copayments.

On the other hand, if you are enrolled in a Medicare Advantage Plan, your plan should give you at least the same coverage as that of the original Medicare. Be sure that your doctors are in the insurer’s network. This would help avoid excess costs. Moreover, find out whether there’s a need for a referral of authorization before getting a care.