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Does Medicare Cover Home Health Care for Dementia?

Does Medicare Cover Home Health Care for Dementia?

Does Medicare cover home health for dementia? This is a heartbreaking question that many low income families are asking. After all, dementia is a challenging condition that progressively impacts various aspects of a person’s life. At different stages of dementia, there’s a need for different types of care and treatments. 

While going to a nursing home or assisted living facility can help dementia patients manage their daily lives, many individuals with dementia thrive best in a familiar environment like their home. 

So, home health care might be better to offer personalized assistance and maintain a familiar environment. But it doesn’t come cheap. Does Medicare cover home health care for dementia? Let’s find out.

Key Takeaways

  • Medicare covers some home health care services for dementia patients, including skilled nursing services, home health aides, therapy services, medical supplies, and medical social services.
  • To be eligible for Medicare-covered home healthcare for dementia, patients must meet general home healthcare eligibility criteria, including being under the care of a doctor and being homebound. 
  • In addition to home health care, other options for dementia care include assisted living, adult day centers, memory care facilities, and hospice care.
  • While Medicare does not cover all aspects of dementia care, Medicaid, Medicare Advantage Plans, and private insurance may cover some of them.

Does Medicare Pay for Dementia Care?

Medicare covers some home health care services for dementia patients. There are different parts and plans of Medicare, covering specific services. Part A and Part B make up the Original Medicare plan, which is the most basic Medicare option. 

There are also Medicare Advantage Plans, Medicare Part D, and Medigap. Here’s a table that highlights each Medicare part and their coverage: 

  • Medicare Part A: Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
  • Medicare Part B: Covers certain doctors’ services (like clinical diagnostic laboratory tests), outpatient care, medical supplies, and preventive services.
  • Medicare Advantage Plans (Part C): Offers an alternative to Parts A and B through private insurance companies, often including additional benefits like dental, vision, and prescription drug coverage.
  • Medicare Part D: Helps cover the cost of prescription drugs.
  • Medigap: Provides additional coverage to fill the “gaps” in Original Medicare (Parts A and B), such as copayments, coinsurance, and deductibles. It’s also offered by private insurance companies.

With this knowledge, the next question is, “How do these plans help with dementia home health care?” Let’s start with Original Medicare. 

Does Original Medicare Cover Home Health Care for Dementia?

The coverage starts with the diagnosis of dementia; it covers the cost of cognitive assessments and other medical tests required to diagnose dementia. From the table above, you can see that Medicare Part B covers diagnostic tests. 

Also, Original Medicare covers the cost of making a personalized plan for the treatment of dementia. Generally, Original Medicare will provide 35 hours of home health care for eligible dementia patients per week. 

If you’re qualified for Medicare-covered dementia home health care, here are some of the covered services: 

  1. Skilled nursing services: This includes services provided by a licensed or certified nurse, such as management and evaluation of your care plan, assessment of your condition, and injections. 
  2. Home Health Aide: A home health aide is tasked with providing personal care services like toileting and bathing. Medicare will only provide coverage for an aide if you need skilled care. 
  3. Skilled Therapy Services: Treatment of dementia often involves therapy services like occupational therapy. If this is part of your treatment plan, Medicare can provide coverage for therapy services performed by a licensed therapist.
  4. Medical Supplies: Medicare offers full coverage of certain medical supplies needed for your treatment. However, they must be provided by a Medicare-certified home health agency (HHA). 
  5. Medical Social Services: If your doctor prescribes services to help you manage the social and emotional aspects of your condition, Medicare offers full coverage for those services. This may include counseling or assistance in finding community resources tailored to your needs. 

Does Medicare Advantage Cover It?

Medicare Advantage plans offer an alternative route to Medicare coverage. Like Original Medicare, they assist with dementia home health care and may include additional services such as transportation to medical appointments.

While we can detail the specific home healthcare services covered by Original Medicare, the coverage under Medicare Advantage varies greatly. So, it’s crucial to carefully review your plan’s benefits to understand the dementia home health care coverage available. 

Who Is Eligible for Medicare-Covered Home Health Care for Dementia?

There are no special eligibility criteria for receiving Medicare-covered home health care as a dementia patient. All you have to do is meet the general Medicare eligibility criteria for home health care, which includes the following: 

  • You must have Medicare
  • You must be under the care of a doctor who certifies that you need home healthcare benefits
  • Your healthcare provider acknowledges that you’re homebound
  • You must be enrolled in a Medicare-approved home healthcare agency

Other Options

Home health care can be an option for managing dementia at an early stage. But as the condition worsens, moving into a senior living facility can be the best course of action. Here are some options you can explore: 

Assisted Living

Assisted living is mostly suitable for seniors in the early stages of dementia. This is because wandering and falls are frequent issues in the later stages, and assisted living facilities don’t have the best security to contain these issues. 

Seniors in the middle stages of dementia can also get care in assisted living facilities, as long as wandering isn’t a frequent issue. 

As for funding, Medicare doesn’t cover assisted living, but it’ll pay for any Medicare-covered service the patient might need. Medicaid, on the other hand, covers some assisted living expenses. But because it’s state-run, you have to check what’s available in your state.  

Adult Day Centers

Adult day centers offer opportunities for social interaction and engagement in supervised activities such as music and exercise programs for individuals with Alzheimer’s and dementia. Getting a dementia patient to an adult day center might be a struggle from the onset. But over time, they adjust and anticipate joining in activities. 

Some of the services adult day centers offer include activities like music and art, health services, nutrition, counseling, therapy, special needs, behavior management, and personal care. 

If you’re thinking about costs, some Medicare Advantage Plans may offer some coverage for adult daycare services. You can also turn to Medicaid if you meet the eligibility criteria. 

Memory Care

Memory care facilities are special homes for people with dementia. You can consider memory care facilities in the later stages of dementia when managing dementia-related behaviors becomes increasingly challenging. 

Memory care facilities provide more personalized care and have safety features like secured entrances and monitored wandering paths to address the unique needs of dementia patients. 

Financial assistance for memory care may be available through Medicare, but they offer limited coverage and generally focus on medical needs. Medicaid offers broader benefits if you’re eligible. 

Eligible veterans may also receive ongoing assistance through the VA from diagnosis to the terminal stage of dementia. Additionally, leveraging home equity is another option for covering memory care costs.

Hospice Facility

Hospice for dementia is a type of care for individuals in the advanced stage of dementia. To start hospice, an allowed provider must certify that the life expectancy of the patient is six months or less. As such, this form of care focuses on managing symptoms and providing comfort for the patient and their family. 

Hospice can be given at home or in a hospital setting. However, several facilities in the country solely serve the purpose of providing hospice care. 

Medicare, Medicaid, and many private insurance plans often cover hospice care. 

FAQs about Medicare Coverage for Dementia Home Health Care

In addition to asking “Does Medicare cover home health care for dementia,” concerned family members often have other important questions that need to be answered. Here are a few of the most common ones.

Can a Dementia Patient Be Cared for at Home?

Yes. In the early stages of dementia, a patient can receive care at home. However, when it gets more serious, you might need to move the patient to a memory care facility. 

Does Medicare Cover Testing for Dementia?

Yes, Medicare Part B covers the testing and diagnosis of dementia. 

Relief Recap

So, does Medicare cover home health care for dementia? It depends. Dementia patients who have been certified as homebound by their doctors may be eligible for dementia home health coverage. They can get coverage for skilled nursing services, home health aides, skilled therapy services, medical supplies, and medical social services. 

Faith is a passionate advocate for social change. She brings a unique blend of professional expertise and personal experience to the discourse on poverty. With a background in humanities and an advanced degree on public health, she has dedicated years to working directly with marginalized communities, both as a volunteer and a seasoned professional.