What Does Medicare Cover for Alzheimer’s and Memory Care?

Alzheimer’s and other forms of dementia and memory loss are a common occurrence in our elderly population. Alzheimer’s is a progressive brain disease that is irreversible because scientists have not yet figured out its exact cause. The CDC estimates that Alzheimer’s disease affects approximately 5.7 million Americans and predicts that number will only grow as our population continues to age. In Hawaii alone, data from the Alzheimer’s Association estimates that approximately 29,000 Hawaiians over the age of 65 have dementia, with that number expected to grow to 35,000 by 2025.


In 2018, it was estimated that total payments for health care, long-term care, and hospice for people with Alzheimer’s and other types of dementia was $277 billion. Medicare covers about half of these costs for patients 65 years and older.

What Does Medicare Cover for Alzheimer’s and Memory Care?


Elderly patients who require assisted living and memory care can expect to spend approximately $5,000 per month in the United States. Assisted living alone is estimated to cost about $4,000 per month but with the specialized training required for staff and therapy programs, and the specific facility design and security that are necessary to keep patients with memory issues safe; there is an additional $1,000 in cost.


Medicare covers inpatient hospital care and some of the doctors' fees and other medical items required to treat Alzheimer's or dementia. Medicare Part D also covers many of the prescription drugs used for treatment. It’s important to know that Original Medicare does not cover any type of long-term care but it does pay for the following:

  • Inpatient hospital care

  • Semi-private rooms

  • General nursing care

  • Diagnostic testing

  • Medications

  • Meals

  • Hospital supplies

  • Hospice care

  • 100 days of skilled nursing care

Medicare Advantage Plans for Alzheimer’s


Special Needs Plans (SNP) are a type of Medicare Advantage Plan that has similarities to PPO and HMO plans. SNPs are only available for kupuna who have special diseases or those with a disabling chronic condition. There are SNPs available for people with dementia, including Alzheimer's disease and only Medicare beneficiaries with dementia are eligible to enroll in these plans. An SNP that is for individuals with memory issues may cover more of the care and medications required for dementia patients than Original Medicare. Speak to a local Medicare agent to discuss your (or your parents) options.


Other Ways To Pay for Dementia Care


Seniors may have access to other types of financial resources that can help pay for the care required for Alzheimer’s and other types of dementia, including:


1. Retirement benefits such as IRAs and annuities that can be cashed out.


2. Retired seniors may have access to private group health insurance that offers additional care for memory issues.


3. Personal savings such as savings accounts and investments.


4. The state of Hawaii provides an optional state supplement for eligible residents who receive Supplemental Security Income benefits through the Social Security Administration. Seniors are entitled to use the supplement to pay for necessities or put toward the cost of room and board in a licensed facility that provides memory care. Apply by filling out an application for federal SSI benefits in person at your local Social Security office.


5. Seniors with low assets and financial resources may qualify for Medicaid. Hawaii’s Medicaid program is called the Med-Quest Division; it provides long-term care assistance, including memory care services under certain guidelines, for seniors with disabilities through the Quest Integration program. To apply, you can call or visit your local Med-Quest Division office, call 877-628-5076, or complete an application online at mybenefits.hawaii.gov.


In addition to financial resources, there may be other types of support available from community organizations such as a local Alzheimer’s association, church, or volunteer group. In Hawaii, we have the Hawaii chapter of the Alzheimer’s Association that does wonderful work supporting our kupuna with Alzheimer’s.


Contact a PBC Agent for Help


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.