Does Medicare Cover Nursing Home Care For Dementia Patients?

The cost of nursing home care for a person with dementia can be overwhelming for most families. As such, it’s important to understand what costs are covered by Medicare. This guide will help you understand if Medicare covers nursing home care for dementia patients.

What Is Dementia?

Dementia is a term used to describe a set of symptoms that can be caused by a number of different diseases. Symptoms of dementia can include difficulty with memory, thinking, problem-solving, language, and other cognitive skills. Dementia is not a specific disease, but rather a collection of symptoms that can be caused by different diseases and conditions.

Does Medicare Cover Nursing Home Care for Dementia Patients?

Yes, Medicare covers nursing home care for dementia patients in certain circumstances. Medicare Part A covers up to 100 days of skilled nursing home care for certain people who are eligible for Medicare. To be eligible, a person must have a qualifying hospital stay of at least three days and need skilled nursing home care to help with their daily medical needs.

In addition, Medicare Part B covers outpatient care in a nursing home or other facility where skilled nursing care is provided. This includes care for dementia patients who need help with activities of daily living such as bathing, dressing, and eating. In order to be eligible for Medicare Part B coverage, a person must be enrolled in Medicare Part B and have a doctor’s order for the care.

What Are the Requirements for Medicare Coverage?

In order to qualify for Medicare coverage for nursing home care for dementia patients, the person must meet the following requirements:

• The person must be eligible for Medicare Part A.
• The person must be under the care of a doctor who has ordered the care.
• The care must be provided in a Medicare-approved facility.
• The care must be medically necessary.

In addition, the person must meet the specific criteria for the type of care they are receiving. For example, Medicare Part A covers up to 100 days of skilled nursing home care for certain people who are eligible for Medicare. To be eligible for this type of coverage, a person must have a qualifying hospital stay of at least three days and need skilled nursing home care to help with their daily medical needs.

What Is Not Covered by Medicare?

Medicare does not cover long-term care or custodial care for dementia patients. Long-term care is care that is not medically necessary, such as help with bathing, dressing, and eating. Custodial care is care that is provided to help with activities of daily living such as shopping and housework.

Medicare also does not cover the cost of medications for dementia patients. Medicare Part D covers some medications, but not all. For more information about Medicare Part D coverage for dementia medications, please contact your Medicare plan.

How Much Does Medicare Pay for Nursing Home Care for Dementia Patients?

Medicare pays for nursing home care for dementia patients on a fee-for-service basis. The amount that Medicare pays for each service is determined by the type of service and the facility where the care is provided. For example, Medicare Part A pays a different amount for skilled nursing home care than it does for custodial care.

Conclusion

Medicare covers nursing home care for dementia patients in certain circumstances. To be eligible, a person must meet the requirements for Medicare Part A or Part B coverage and have a doctor’s order for the care. Medicare does not cover long-term care or custodial care for dementia patients, and it does not cover the cost of medications. The amount that Medicare pays for each service is determined by the type of service and the facility where the care is provided.