Doesn’t Medicare Pay for That? Understanding Medicare Coverage for Dementia Care

medicareCallers to our 24/7 Helpline often want to know more about care resources.  In these discussions, counselors frequently hear the question, “Doesn’t Medicare pay for that?”  Much to the dismay of many, the answer is often, “No.”  As families look ahead to planning for how they will pay for a loved one’s care, it’s important to have an understanding what Medicare covers, together with what it does not cover.

Here are some important facts about Medicare, with respect to the care of a person with dementia:

Medicare does not pay for on-going “routine” care of a person with dementia.

 

  • Instead, Medicare coverage is focused on rehabilitation services, following an illness or injury for which skilled nursing services are needed. For example, Medicare may cover home health visits and physical therapy following surgery for a hip fracture.  Or, Medicare may cover these services being provided in a skilled nursing facility.  Whether the services are provided in the home or in a nursing home, the services will be

 

  • Medicare Part B does help to pay for the evaluation/diagnosis of a person with memory problems. This is part of coverage for physician office visits. Medicare Part A will also help pay for evaluation that sometimes takes place as part of a hospitalization.

 

  • Medicare does not pay for Adult Day Care .

 

  • Medicare does not pay for a daily caregiver to stay with the person in the home while a caregiver goes to work every day.

 

  • Medicare Part D provides prescription drug coverage. Enrollment periods run from November to December every year.  If changes in a person’s Medicare Part D plan are needed, it’s important to make them during the enrollment period; otherwise, there will be a wait until the next enrollment period.

 

  • The Medicare website offers a useful tool for searching for nursing homes. It is called Nursing Home Compare, and it allows a person to search by county, state, zip code, etc. Extensive information on each facility is provided, including a rating based on the facility’s last inspection. An easy way to access this part of the Medicare website is to simply “google” the words Medicare Nursing Home Compare.

 

  • Medicare has coverage for hospice services for a beneficiary who, in a physician’s judgment, may have six months or less of life. It is important to keep in mind that this six-month expectation is only a physician’s estimate and that many people live considerably longer after entering hospice care.  These services require a physician’s order.

 

  • For additional Medicare information, call Medicare at 1-800-633-4227, or visit the website at medicare.gov.

 

Susan Formby, LCSW

Care Consultant GA Chapter

 

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