Medicare Coverage of Alzheimer's Care

What It Is

Medical services and care for patients with Alzheimer's disease

What's Covered

Medicare doesn't have a special category of coverage for Alzheimer's disease. And the single most important thing to understand about Medicare coverage for Alzheimer's patients is that Medicare doesn't pay for long-term care, whether in a nursing home, assisted-living facility, or at home. However, Medicare does cover some medical services of particular help to Alzheimer's patients. These include:

  • Therapeutic services. Medicare Part B covers outpatient physical, occupational, and speech therapy for an Alzheimer's patient. The treatment has to be prescribed by the patient's physician and be provided by a Medicare-certified therapist.

  • Psychological or disease-management counseling. Counseling by nonphysicians is not technically medical care, and normally Medicare doesn't cover it. But some Alzheimer's care specialists are clinical psychologists or medical social workers rather than physicians. Medicare Part B covers outpatient counseling concerning the management of Alzheimer's either from a physician or from a Medicare-certified psychologist, medical social worker, or other nonphysician provider. If the treatment is provided by a nonphysician, it must be prescribed by the Alzheimer's patient's doctor.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B plans.) To find out whether your plan provides extra coverage or requires different co-payments for Alzheimer's care, contact the plan directly.

If you have a Medicare Part D prescription drug plan: Medicare Part B doesn't cover drugs prescribed by a physician for outpatient use to manage symptoms of Alzheimer's. But if you're enrolled in a Medicare Part D prescription drug plan, such drugs are likely to be covered by that plan. For details of coverage and co-payments, check directly with the Part D plan itself.

What Medicare Pays

For outpatient physical, speech, or occupational therapy -- or for outpatient counseling services -- Medicare pays 80 percent of the Medicare-approved amount. For physical and speech therapy, there's a combined yearly cap of $1,810 on how much Medicare Part B will pay. For occupational therapy, there's a separate cap of $1,810.

Warning: The yearly caps on outpatient physical, speech, and occupational therapy don't apply if a patient receives the therapy at a hospital outpatient clinic rather than in a therapist's office or at home.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

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24 Comments So Far. Add Your Wisdom.

20 days ago

I hate to use the word "expendable" but those Republican legislators surely ,have family members or friends with AD. Ryan in particular must realize the need of the millions that are sufferers His budget needs total rejection We must mount a program of education for this guy.. In the UK the social MEDICINE programs covers so much more and we should demand in the Democrats PARTY PLATFORM THAT THIS SUBJECT OF CARE BE ADDRESSED. HILLARY SEEKING THE WOMENS VOTE SHOULD ADDRESS THIS NEED AND WHEN SHE APPEARS IN YOUR AREA BE SURE AND BRING THIS UP. Vote for the legislators who honestly will support a revised national effort. This situation mirrors the student debt.

9 months ago

my girlfriends brother put all of the assets totaling 500,000 into a trust account upon diagnosis of the father with alzeimers including a home. the father had been in the home for 6-7 years and not a penny of his money was touched .Medicaid and medicare paid all expenses. so the bottom line is you pay nada if you hide your money period.PS the mother was still living and received all of his and her ss benefits as well.

10 months ago

My Mother was diagnosed with Alzheimer's last year and we had to put her into a nursing home. She wants to go home so bad she cries. I live in California and she in Texas. She cries for me to come home and I will but I am not sure how to go about getting paid for caring for her. I will have to leave my job and move back to Texas. Any suggestions?

about 1 year ago

Since some of these comments are 'years' old, does this article need to be updated to reflect changes in government benefits? Sadly, I do not believe there are any changes to drive an update. In addition to lack of Medicare, Medicaid and secondary insurance Alzheimer's benefits for our frail, elderly citizens we cannot rely on Elder Affairs to help relieve the pain and suffering either. We have only the hope the gigantic baby boomer generation will force legislation in time for some of us.

over 1 year ago

It is amazing that the majority of people (I was included) are not aware that Medicare & Secondary insurance DO NOT cover long term care which depending on the level of dementia will cost between $4,000 to $10,000 a month. So as ClaraV above mentioned - there goes your nest egg. There must be a solution found for this unjust situation.

over 1 year ago

Since I am the 7/24/365 sole caregiver of my 84 year old husband, who has ciortical dementia and numerous medical conditions and have been caring for him for 13 years, I finally hired a company who provides a "sitter" for 4 hours a day, once a week. It enables me to grocery shop and pick up prescriptions but it's "out of pocket" money. Eventually, (soon) my husband will have to go to an "assisted living" facility which will also be an "out of pocket" expense that will lower my already frugal standard of living, possibly forcing me to sell our handicap renovated townhouse (an expense I already paid for) to accomodate my husband. .I am worn out and in need of medical care for myself.and worry constantly about our finances or rather lack thereof, for my husband's care and my own. Retirement has not been "golden".

almost 2 years ago

Now I really am depressed. What is the use of either of us continuing to live if all we have to look forward to is economic devastation? Not to mention the horror of complete loss of functioning as a person. And realizing how many citizens are already suffering economically and personally is overwhelming. How sad for our society that end of life be so horrible for so many Alzheimer's patents and their families.

Anonymous said about 2 years ago

My mother suffers from Alzheimer's and we take care of her in her home. It's been getting very difficult these past months. Since taking care of my mom it been an eye opener for me. This is why I am buying Long Term Care insurance to provide this income for me in case I become disabled. I do not want to burden my family. It's well worth it!

over 2 years ago

However... if u r eligible for both medicare and medicaid u must be careful before accepting assist for certain inhome services (ie nursing) even if prescribed by dr and medicare approved! We receive medicaid home health aide while I am at work but not nursing so when we asked medicare provider submitted and received approval! Yeah... only to find out shortly after that this approval reduced our HHA 3 hrs/wk!! SO SO FRUSTRATING

over 2 years ago

aftr 4 and a half years in a nursing home i really need financial help.

over 2 years ago

Amazing! good info. but dissapointed that we have to use all our resourses before he can get medicaid.

over 2 years ago

This is the most unbelievable part of Medicare and or secondary health insurance providers. Because this disease renders its victims almost completely helpless as it progresses, round the clock care and lots of it are required. I have been taking care of my mother for 11 years now and it is a lot of work. The only way a nursing home would take her was at full price of over 200.00 per day. Medicare won't provide anything nor will her secondary insurance. Medicaid will only cover her if she uses up all her existing assets including her home. Then when she dies the government will take anything left of her estate to pay back Medicaid. It is the best kept secret in health care and you don't find this out until one of your parents end up with disease. You don't here any politicians mentioning this when they sing the praises of government's handling of the elderly's health care. Nursing homes actually take advantage of this condition by either charging an arm and a leg for custodial care or draining every penny available.

over 2 years ago

What does one do if there is no one nearby to care for an Alzheimer' s patient? Just let them wander off and get picked up by police, or turn into vagrants? I am guessing Medicad is supposed to take up this slack. But isn't Medicaid short of funds, and overwhelmed with needy people? So does this mean an "asylum", as it were, for isolated Alz. patients who have run out of resources? It's beginning to feel a lot like we are tossing out our elders. This is really wrong. At least I think so.

almost 3 years ago

the information is very helpful, but my question is, will alhsheimers patients and dementia patients have to have a home health person come in the home because won't pay for long term care ? i don't want that burden on my family.

over 3 years ago

All of you are such a blessing.

over 3 years ago

Just to give all of the ones of you that have advised me and have been so helpful since my mama was diagnosed, I have been very busy. We have done the legal POA for medical and financial so that is no longer a worry for any of us in the family and we can just concentrate on making mama happy and comfortable for as long as we have left with her. She is rapidly going downhill and this is difficult to watch but God has been giving me the strength I need to get through each difficult day. Keep me in your prayers and I still need your support and advice in every way.

over 3 years ago

Everything. Did not know Medicare helped at all.

over 3 years ago

necessary information for the future.

almost 4 years ago

Excellent information.

almost 4 years ago

Info was helpful, however disappointing. People with Alzheimer's need long term care. There should be something available for these people. Wiping people out financially is just not right. We work all our life paying into Medicare only to be refused when we really need it.

about 4 years ago

Thanks for the info. I could definitely use the physical therapy for my Mom. I'm afraid if she doesn't do something soon she'll be in a wheel chair. She walks rather poorly now and won't let her daily care giver help her with any exercise. A new face may get her put a little effort into exercising.

Anonymous said about 4 years ago

Very interesting, nice to know. MostMedicare says nothing about all this.

over 4 years ago

Very interesting - I have been paying for PT since the $1800.00 was used up for the year 2010 - I am told that if there cannot be improvement they will not cover PT. My George needs it just to be able to walk on his own. with a cane. Without it I guarantee he would be in a wheel chair. It's really a sad situation - I'm rapidly being cleaned out financially... I guess it is what it is. If he had any idea what has happened to us financially after working so hard to build a nest egg he would be devistated. Better that he doesn't even realize what's happened..

over 4 years ago

All of the info on what is covered by medicare very helpful, thanks.


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