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What Medicare Coverage is Available for a Parent with Dementia?

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Summary: Dementia is a loss of certain brain function, according to the National Institutes of Health (NIH). It affects your ability to think and remember, and generally gets worse over time. Medicare coverage of dementia care varies from some basic coverage under Part A and Part B to a specialized type of Medicare Advantage plan that you may qualify for.

A dementia diagnosis can be devastating for the entire family. If one of your parents develops symptoms of dementia, you will want him or her to have the best possible care. You may also want to know what Medicare coverage is available to keep medical costs as low as possible.

Understanding dementia

As dementia symptoms progress, your parent may be unable to perform some daily activities, according to the Alzheimer’s Association. Memory loss is a common symptom of dementia. Other symptoms might include:

  • Loss of reason and judgment
  • Inability to focus
  • Problems with communication

Dementia symptoms may affect the patient more and more as the disease progresses. As your Mom declines, she may not be able to live on her own and take care of herself. She may need senior home care at some point. That is when you may want to know about Medicare coverage.

Original Medicare coverage for dementia treatment

Original Medicare has two parts. Part A is hospital insurance that helps pay for time your parent might have to spend in the hospital as an inpatient. It also covers some of the expenses of skilled nursing care if your parent needs it for medical reasons. Part A does not cover senior home care for personal care like bathing, if that is the only care your parent needs.

Part B typically helps pay the costs of other medical care like visits to the doctor. It also covers some preventative care. It does not include senior home care unless it’s medically necessary.

Medicare coverage: what is a Medicare Special Needs Plan?

A Special Needs Plan (SNP) is Medicare coverage available through a type of Medicare Advantage plan.

A Chronic Condition SNP covers people who qualify by having a certain health condition. Your mom must have that condition to be able to enroll in one of these plans. There are SNPs for people with dementia. You can search Medicare Advantage plans in your mom’s area by entering his zip code in the box on this page.

Private insurance companies approved by Medicare can offer these plans. SNPs can charge a monthly premium. Your parent will also continue paying a Part B monthly premium. Some SNPs might pay a part of the Part B premium, if your parent qualifies.

Medicare coverage: what else should I know about SNPs?

  • Medicare SNPs include prescription drug coverage.
  • Your Mom may have to see doctors in the SNP’s provider network.
  • Not every type of SNP may be available where your mom lives.
  • Some Medicare SNPs offer a care coordinator. This person helps you and your parent get the information you need to manage their condition. Not all plans offer this service.

Medicare coverage: enrolling in a Medicare SNP

Your Mom or Dad might be able to enroll in a Medicare SNP when she or he is first eligible for Medicare. The Medicare Initial Enrollment Period usually starts three months before the month your parent turns 65. It continues for three months after the birthday month, for a total of seven months. Remember, your parent has to meet the requirements for an SNP.

Your parent might also be able to enroll in a Medicare SNP during a Special Enrollment Period. For example, she or he may become eligible for an SNP because of a dementia diagnosis or moving to a nursing home.

A Medicare SNP may be a good way to make sure your parent has Medicare coverage for dementia care. To see if there are SNPs  in your area, enter your zip code below.

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