Quick Answer
Medicare does not cover long-term memory care facility costs. Memory care is considered custodial care, which Medicare explicitly excludes. However, Medicare does cover medically necessary services for dementia patients including physician visits, short-term skilled nursing facility care, home health, and hospice. Families typically rely on Medicaid, long-term care insurance, or personal savings to cover memory care facility costs.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Memory Care Facility (Room & Board) | Not Covered | Medicare does not cover custodial care - ongoing supervision and personal care in a memory care facility |
| Medicare Part B (Outpatient) | Covered | Covers physician visits, cognitive assessments, outpatient therapy, and care planning |
| Medicare Part A (SNF) | Partial | Covers short-term skilled nursing facility care up to 100 days following a qualifying hospital stay |
| Medicare Part A (Hospice) | Covered | Covers hospice care when life expectancy is 6 months or less |
| Medicare Advantage (Part C) | Varies | Some plans offer supplemental benefits like caregiver support or adult day care |
| Medicaid | May Cover | Medicaid covers long-term custodial care for those who meet income and asset requirements |
Understanding Your Coverage Options
Memory Care Facilities - What Medicare Covers and Doesn't
Custodial care is excluded from MedicareMemory care facilities are specialized residential settings for people with Alzheimer's disease, dementia, and other cognitive conditions. They provide 24-hour supervision, secured environments, and assistance with daily activities such as bathing, dressing, and eating.
Medicare classifies this type of care as **custodial care** - help with daily activities that does not require a licensed medical professional. Medicare explicitly excludes custodial care from coverage, regardless of the setting.
The average cost of memory care in the United States ranges from $4,500 to $7,000 per month. Without coverage, this becomes one of the most significant financial burdens a family can face.
What It Doesn't Cover
- Room and board in a memory care facility
- 24-hour supervision and secured environment costs
- Personal care assistance (bathing, dressing, eating)
- Non-skilled companion care or supervision
Memory care facilities typically cost $4,500–$7,000/month. Medicaid may cover these costs for those who qualify based on income and assets.
The Coverage Gap
Medicare's most significant limitation for dementia patients is the custodial care exclusion. Once a patient no longer needs skilled medical services, Medicare coverage ends - even if they still require 24-hour supervision in a memory care facility.
Medicare Part B (Outpatient Services)
Covered for medically necessary servicesMedicare Part B covers the outpatient medical services that dementia patients use regularly. This includes visits to physicians and neurologists, cognitive assessments, outpatient mental health services, and medically necessary therapy.
Part B also covers the cognitive impairment care planning benefit - a comprehensive visit where your physician develops a written care plan for your diagnosis. This is covered at no cost-sharing with a participating provider.
What It Covers
- Physician and specialist visits
- Cognitive assessments and neuropsychological testing
- Comprehensive care planning for cognitive impairment
- Outpatient mental health services
- Speech, occupational, and physical therapy
- Home health services ordered by a physician
- Durable medical equipment
What It Doesn't Cover
- Memory care facility room and board
- Non-skilled personal care or supervision
You pay 20% coinsurance after the $283 annual Part B deductible. A Medigap plan can eliminate this cost-sharing.
Medicare Part a (Skilled Nursing & Hospice)
Covered for short-term skilled care and hospiceMedicare Part A 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, coverage ends.
For end-stage dementia, Medicare Part A covers hospice care when two physicians certify a life expectancy of 6 months or less. Hospice provides comfort-focused care including nursing visits, aide services, medications for comfort, and respite care for family caregivers.
What It Covers
- Short-term skilled nursing facility care (up to 100 days per benefit period)
- Skilled nursing, therapy, and wound care in a SNF
- Hospice care for terminal dementia diagnosis
- Inpatient hospital stays for acute medical conditions
What It Doesn't Cover
- Long-term memory care facility stays
- SNF care beyond 100 days per benefit period
- Custodial care without a skilled nursing need
SNF: $0 for days 1–20, $217/day for days 21–100. Hospice: covered in full with small copays for medications and respite care.
✦ Frequently Asked Questions
Jagger Esch
AuthorJagger Esch is the Medicare Educator at MedicareFAQ and the founder of Elite Insurance Partners.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare.