As dementia diagnoses continue to rise across the country, many families are left asking one critical question: Is dementia care covered by Medicare? The answer is nuanced and often misunderstood. While Medicare does offer some support for medical needs related to dementia, it does not cover the long-term, non-medical care that most individuals eventually require.

In this guide, we will take a closer look at what dementia care entails, what Medicare will and will not pay for, and what other resources are available to families in need. Understanding your options now can make a significant difference in how you prepare for the road ahead.

What Does Dementia Care Involve?

Dementia is not a single disease but a group of conditions marked by cognitive decline, including memory loss, impaired judgment, confusion, and behavioral changes. The most common type is Alzheimer’s disease, but other forms include vascular dementia, Lewy body dementia, and frontotemporal dementia.

As dementia progresses, it affects a person’s ability to live independently. They may forget to eat, wander from home, become disoriented, or struggle with basic hygiene. Over time, individuals with dementia often require increasing levels of support, ranging from simple reminders to 24-hour supervision and full assistance with daily activities.

Dementia care can include:

• Assistance with bathing, dressing, and grooming
• Medication reminders and health monitoring
• Help with meal preparation and eating
• Support with mobility and fall prevention
• Supervision for wandering or confusion
• Emotional support and companionship
• Transportation to doctor appointments

These types of services are often provided in the home by professional caregivers, through adult day care programs, or in memory care facilities. The need for consistent, non-medical assistance is a hallmark of dementia care—and this is where Medicare coverage begins to fall short.

What Parts of Dementia Care Does Medicare Cover?

Medicare is a federal health insurance program primarily for individuals age 65 and older. It covers medical care but does not provide broad support for personal or custodial care—two types of assistance that become essential for many dementia patients.

Here is a breakdown of what Medicare will typically cover:

Medical Appointments and Diagnostic Services

Medicare Part B covers doctor visits, including specialists such as neurologists and geriatricians. It also covers cognitive assessments, lab work, and brain imaging needed to diagnose dementia or rule out other causes of memory loss.

Short-Term Hospital and Skilled Nursing Care

If a dementia patient is hospitalized—for example, due to an infection or injury—Medicare Part A covers inpatient care, including hospital stays and rehabilitation. Following a qualifying hospital stay, Medicare may also cover a short-term stay in a skilled nursing facility, usually up to 100 days. However, this is limited to situations where the patient needs skilled nursing or therapy services.

Limited Home Health Services

Medicare will pay for certain home health services if a doctor certifies that they are medically necessary. These services may include intermittent nursing care, physical therapy, or speech-language therapy. The key limitation is that Medicare only covers part-time or intermittent care, and the person must be considered “homebound.”

It does not cover full-time home care, custodial care, or help with daily living activities such as bathing, dressing, or meal preparation.

Hospice Care

If a patient with dementia is diagnosed with a terminal illness and given a life expectancy of six months or less, Medicare will cover hospice care. Hospice includes pain management, palliative care, and emotional support, provided at home or in a hospice facility.

What Medicare Does Not Cover

It is equally important to understand what Medicare does not pay for. This is where families are often caught off guard.

Medicare does not cover:

• Full-time home care or supervision
• Memory care in assisted living communities
• Personal care assistance with bathing, dressing, and eating
• Long-term care in a skilled nursing facility after the 100-day limit
• Companionship or supervision services to prevent wandering

These services are classified as non-medical or custodial care, even though they are essential for a person with dementia to live safely and comfortably.

What Are the Alternatives for Covering Dementia Care Costs?

Since Medicare does not offer complete coverage for dementia-related care, families often need to consider other funding options. Planning early and exploring each of these avenues can help avoid financial strain later on.

Medicaid

Medicaid is a joint federal and state program that provides health coverage to low-income individuals. Unlike Medicare, Medicaid does cover long-term custodial care, including in-home care and memory care facility costs, for those who qualify. Each state has different income and asset limits, and Illinois has a Medicaid waiver program that allows individuals to receive care in their homes rather than institutions.

If your loved one qualifies, Medicaid can be one of the most reliable ways to receive affordable, long-term dementia care.

Assisting Hands Home Care in Palos Heights is a Medicaid-approved provider, which means families in the area can access quality in-home care under the Medicaid program.

Long-Term Care Insurance

If your loved one purchased long-term care insurance before their diagnosis, the policy may help cover the costs of in-home care, adult day programs, or residential memory care. It is important to check the policy terms carefully to confirm what types of dementia care are included and for how long.

Veterans Benefits

Veterans and surviving spouses may qualify for financial support through the VA Aid and Attendance benefit. This program provides a monthly payment that can help offset the cost of in-home or facility-based care.

Private Pay

For families who do not qualify for public programs or insurance benefits, private pay is another option. Some families use retirement savings, pensions, home equity loans, or reverse mortgages to cover the cost of dementia care. In some cases, adult children contribute jointly to help their parent remain at home.

Why Early Planning Matters in Dementia Care: A Guide for Families

Dementia is a condition that changes over time—often gradually, then suddenly. What may begin with occasional forgetfulness can progress to daily confusion, wandering, or the inability to manage basic routines. That’s why early planning is more than a recommendation—it’s a necessity.

By taking action before care becomes urgent, families have time to consider all available options, prepare financially, and involve their loved one in important decisions about their future.

Here are some key steps to take now:

• Schedule a cognitive assessment to confirm the diagnosis and understand your loved one’s current condition.
• Speak with a financial advisor who specializes in elder care planning to explore funding options, including long-term care insurance or reverse mortgages.
• Connect with a Medicaid caseworker to learn about eligibility and programs available in Illinois for in-home or memory care support.
• Research local in-home care providers with experience in dementia and Alzheimer’s care. Focus on those who offer flexible care plans that can adjust as needs change.
• Prepare legal documents, such as a power of attorney and advance healthcare directive, to ensure your loved one’s preferences are respected.
• Have an open conversation with family members to divide responsibilities and set expectations around care and support.

Early planning gives families more control over the situation and helps avoid stressful, last-minute decisions during a medical or behavioral crisis. It also gives your loved one the opportunity to be part of their own care plan while they still can.

Personalized Dementia Home Care from a Medicaid-Approved Provider in Palos Heights

Finding the right care for a loved one living with dementia is deeply personal—and often overwhelming. At Assisting Hands Home Care in Palos Heights, we’re here to make that journey easier. Our team provides compassionate, in-home dementia care designed to support individuals through every stage of memory loss.

Our caregivers are specifically trained to understand the complexities of dementia, including changes in behavior, memory, and emotional needs. Whether your loved one requires a few hours of support each week or around-the-clock assistance, we develop a care plan tailored to your family’s needs.

As a Medicaid-approved provider, we also assist families in navigating financial resources that can make long-term care more affordable. Our goal is to help your loved one remain safely and comfortably at home while giving you confidence and peace of mind.

If you’re ready to explore care options or have questions about coverage, we’re here to help.

Call Assisting Hands Home Care in Palos Heights at (773) 207-3767 to schedule a free, no-obligation in-home consultation.