Caring for a family member with dementia can be a challenging task. As dementia progresses, individuals may require more specialized care than what can be provided at home. Nursing homes provide skilled care in a supervised setting, but the cost of such care can be prohibitive. Medicare, the federal health insurance program for those over 65, may cover some of the costs of nursing home care for dementia, but it is important to understand the specifics of the coverage.
What Is Covered Under Medicare?
In general, Medicare covers skilled nursing home care, but not custodial care. Skilled nursing care is medical care provided by a licensed nurse, usually in a nursing home or hospital setting. This care is usually provided in order to treat an illness or injury, or to help with recovery after a hospital stay. Custodial care, on the other hand, is provided by an aide or nurse’s aide, and is of a non-medical, supportive nature. This type of care is necessary for those who are unable to perform activities of daily living, such as eating, bathing, and dressing, due to a physical or cognitive disability, such as dementia.
Does Medicare Cover Nursing Home Care for Dementia?
The answer to this question depends on the type of care needed. Medicare will cover the cost of skilled nursing home care for dementia, but only if the care is medically necessary. In other words, if the skilled care is needed in order to treat a medical condition or to help with recovery after a hospital stay, then Medicare will cover the cost. However, if the care is needed for custodial care, such as help with activities of daily living, then Medicare will not cover the cost.
What Does Medicare Cover?
If the care needed is medically necessary, then Medicare will cover a portion of the costs. Medicare Part A covers up to 100 days of skilled nursing home care, as long as the care is medically necessary and a physician orders it. During this time, Medicare covers most of the cost of the care, with the patient responsible for paying a daily coinsurance amount. If the care is needed beyond the 100 days, Medicare will cover a portion of the costs, but the patient is responsible for a larger portion of the cost.
What Does Medicare Not Cover?
As mentioned earlier, Medicare does not cover custodial care, which is often needed for those with dementia. This type of care includes help with activities of daily living, such as eating, bathing, dressing, and using the restroom. If this type of care is needed, then the patient must pay for it out of pocket, or look for other sources of funding, such as long-term care insurance or Medicaid.
In 2023, Medicare will cover some of the cost of nursing home care for dementia, but only if the care is medically necessary and ordered by a physician. If the care needed is of a custodial nature, such as help with activities of daily living, then Medicare will not cover the cost, and the patient must pay for it out of pocket or look for other sources of funding. It is important to understand the specifics of Medicare coverage in order to ensure that all needed care is covered.