Medicare coverage for dementia is dependent on the patient’s need.  Medicare covers services that are “reasonable and medically necessary” for the treatment of any condition that has resulted in a loss in abilities and health.  Medicare cannot deny services because of a diagnosis of dementia.

Medicare does cover home health care services for patients with dementia, as long as the person requires the skills of a qualified provider.

It is important to understand what you are signing when you are seeking services from a health care provider. You don't want to pay for something that the provider is responsible for paying.  Supplemental insurances vary by policy. It is very important to understand what your policy does cover. More importantly what it does not cover.

• Does the individual have Medicare Part A (Hospital Benefit) and Part B (Outpatient Benefit)?
• Does the individual have a supplemental insurance policy?
• Have you discussed coverage with the insurance providers?
• Are any out-of-pocket expenses required?  If so, are they affordable?

Medicare Coverage

Common Questions

On-line Resources

Contacts

• About Medicare and Dementia:  http://www.alz.org/care/alzheimers-dementia-medicare.asp
• Medicare Coverage and Dementia: https://www.mymedicarematters.org/coverage/parts-a-b/conditions/

• Medicare  1-800-633-4227
• Blue Cross Blue Shield of Alabama: 1-803-735-1034
• Cahaba Government Benefit Administrators: 1-877-567-7271
• Palmetto Government Benefit Administrators: 1-803-735-1034