Medicare and dementia care: what's covered, and help for caregivers

Checking for memory problems

Your provider may check for signs of dementia, including Alzheimer's disease, during a regular visit or your yearly wellness visit. Signs include trouble remembering, learning new things, concentrating, managing money and making decisions. Depression, anxiety and delirium can cause confusion too, so it's important to find the cause.

A full cognitive assessment and care plan

Medicare covers a separate visit to fully review your thinking and memory, confirm a diagnosis like dementia, and make a care plan. Bring a spouse, friend or caregiver. The provider may review your medicines and history, look at the support your caregiver can give, help with your advance care plan, refer you to a specialist, and connect you with community resources like adult day programs and support groups. The Part B deductible and 20% coinsurance apply.

Training for caregivers

If your provider decides it's part of your treatment plan, Medicare covers training for a family member or other unpaid caregiver, like how to give medicines and help with care. Sessions can be individual or group, in person or by telehealth, and you don't have to be there. You pay 20% of the Medicare-approved amount.

The GUIDE program

GUIDE (Guiding an Improved Dementia Experience) is a Medicare program offered by participating care teams. It gives people living with dementia and their caregivers a care navigator, round-the-clock access to a care team or helpline, caregiver training and support, help connecting to services like meals and transportation, and, for eligible caregivers, respite care up to a yearly limit (starting at $2,500 and adjusted for inflation). There's no cost sharing for GUIDE services.

You may qualify if you:

• Have dementia, confirmed by a GUIDE clinician.
• Have Part A and Part B, with Medicare paying first, and aren't in a Medicare Advantage plan (including Special Needs Plans) or PACE.
• Aren't in hospice and don't live in a long-term nursing home or memory care unit.

It's voluntary, your regular Medicare stays the same, and you can stop at any time. Ask your doctor whether they take part, or find a participating program on CMS's GUIDE page.

What Medicare doesn't pay for

Medicare doesn't cover long-term custodial care, like ongoing help with bathing and dressing at home or in a nursing home. See paying for long-term care. When the time comes, Medicare covers hospice care, and Medicaid may cover long-term care if you qualify.