Does Medicare Cover Alzheimer's Care?

Medicare Part B covers the outpatient services most commonly used in the early and middle stages of Alzheimer's disease. This includes visits to your primary care physician and neurologist, cognitive assessments and diagnostic testing, outpatient mental health services, and medically necessary speech and occupational therapy.

CMS added a dedicated cognitive impairment care planning benefit under Part B. Beneficiaries diagnosed with cognitive impairment - including Alzheimer's disease - are entitled to a comprehensive care planning visit with their physician, during which a written care plan is developed. This visit is covered at no cost-sharing when performed by a participating provider.

Part B also covers the Annual Wellness Visit, which includes a cognitive assessment. If your doctor identifies cognitive concerns, they can refer you for further evaluation and care planning.

Medicare Part A covers inpatient hospital stays when an Alzheimer's patient requires acute medical treatment - for example, for a fall, infection, or behavioral crisis. Part A covers the first 60 days of a hospital stay after you pay the $1,736 per-benefit-period deductible.

Part A also covers short-term skilled nursing facility (SNF) care following a qualifying hospital stay of at least 3 days. Medicare covers days 1–20 in full, and days 21–100 with a $217/day coinsurance. After 100 days, Medicare coverage ends.

This is a critical distinction for Alzheimer's families: Medicare covers skilled care (nursing, therapy, wound care) but does not cover custodial care (help with daily activities). Once a patient no longer needs skilled services, Medicare coverage ends - even if they still require 24-hour supervision.

Medicare Part D covers FDA-approved prescription medications used to treat Alzheimer's disease. The most commonly prescribed Alzheimer's medications - cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the NMDA receptor antagonist memantine - are covered by most Part D plans.

Leqembi (lecanemab), the first disease-modifying Alzheimer's therapy, is covered under Medicare Part B rather than Part D because it is administered as an IV infusion by a physician.

Coverage and cost-sharing for Alzheimer's medications vary by plan formulary. Compare Part D plans during Open Enrollment (October 15 – December 7) to ensure your specific medications are covered at the lowest cost.

Medicare Advantage plans are required to cover all the same services as Original Medicare, including all Alzheimer's-related medical care. Some plans offer supplemental benefits specifically relevant to Alzheimer's patients and their caregivers, such as in-home support services, caregiver respite care, and adult day health programs.

However, Medicare Advantage plans use provider networks, so you must use in-network physicians, specialists, and facilities. For Alzheimer's patients who may need to see multiple specialists, network restrictions can be a significant consideration.

Medigap plans cover the cost-sharing gaps left by Original Medicare - deductibles, coinsurance, and copays. For Alzheimer's patients who use significant medical services, this protection can be extremely valuable.

Medigap Plan G is the most comprehensive option for new Medicare enrollees. It covers the Part A deductible ($1,736), Part A coinsurance for hospital stays and SNF care, and 100% of Part B coinsurance after the $283 annual deductible.

Medigap does not cover long-term custodial care. Families planning for Alzheimer's care should consider long-term care insurance, Medicaid planning, or self-funding strategies for custodial care costs.