When dementia interferes with the daily life of a loved one, many families and caregivers consider an assisted living facility. Assisted living is a type of long-term care (also called custodial care) of services and supports for personal care needs, which include activities of daily living (ADL) like housekeeping, dressing, bathing, meal preparation, eating, medication management, and mobility. If you’re considering moving someone you care about into an assisted living facility, understand that Medicare will not pay for these types of personal care costs, nor will it cover room and board. However, these may be some other options to help cover the costs of dementia-related items and services.
Medicare & Dementia Care
The Medicare program may help pay for other services related to dementia care, such as, inpatient hospital care, physician fees, certain medically necessary items, and short-term skilled nursing home care for up to 100 days. In certain cases, when Alzheimer’s special care units (SCUs), also called memory care units, qualify as skilled nursing services, Medicare may cover some of the costs. In addition, hospice care delivered in the home, a nursing facility, or an inpatient hospice facility may be covered for people with dementia who are near end of life.
Medicare Advantage Value-Based Insurance Design (VBID)
In 2018, the Centers for Medicare & Medicaid Services (CMS) began allowing beneficiaries with dementia to join the Medicare Advantage Value-Based Insurance Design (VBID) Model. This value-based program gives private health insurers selling Medicare Advantage plans the opportunity to offer enrollees with specified chronic conditions (such as dementia), supplemental benefits, reduced cost sharing, and flexible plans, focused on services of highest clinical value to positively affect their health. For more information about Medicare Advantage Value-Based Design Plans, contact a licensed sales agent at (888) 815-3313 – TTY 711 to help you find the right Medicare coverage for your needs.
Programs of All-Inclusive Aid for the Elderly (PACE)
Programs of All-Inclusive Aid for the Elderly (PACE) is a Medicare and Medicaid program available in some states that helps older adults live at home instead of a nursing home or assisted living facility. PACE programs can help with activities of daily living, adult day primary care, meals, medical specialty services, and more. In addition, Medicare beneficiaries with dementia and limited income may be eligible to join a state Medicaid program that covers long-term services, including nursing home care. To find out if you’re eligible for Medicaid or PACE contact your local Medicaid office.