Does Medicare Cover Memory Care? 

Having a good memory serves many important functions, including protecting your physical and mental health.. Memory allows you to learn, but can also contribute to your quality of life. Your memories give you the ability to relive and recount your history, but it can also play a large part in your safety.  We all rely on memory in order to perform daily functions, including driving, cooking, bathing, and more. 

Seniors are more vulnerable than other populations to memory loss. Since individuals 65 and over are eligible for Medicare, along with some people under 65 who qualify due to certain disabilities, Medicare coverage for memory care is a common concern.

Your Memory as You Age

Unfortunately, memory is often one of the most affected facets of mental health with age. Many seniors find it more difficult to remember things with age, but simple memory lapses are normal and common. What isn’t common, however, is forgetting information about who you are, where you live, or who family members and loved ones are.

People who struggle to recall these types of details may be experiencing the effects of medical conditions like Alzheimer’s Disease or dementia. These conditions are marked by the inability to recall day-to-day details or identifying family members. They may also include mentally and emotionally projecting oneself into another place and time despite being physically present in the here and now. This disorientation as to time and space is especially pronounced in dementia, and trouble with memory only tends to get worse with time when left untreated.

How are diseases that affect memory treated?

Memory care is a medical sub-discipline focused on treating and preventing diseases that affect memory. Some treatment options for these diseases may include prescription medications, but others may include working with memory therapists. Some people with Alzheimer’s or dementia will require live-in care, but others may need to reside in a memory care facility where nursing staff can be available 24 hours a day.

Does Medicare cover live-in memory care facilities?

Even though Original Medicare does not include long-term care coverage, there may be help available depending on your condition. If you have concerns about your memory health, please discuss it with your physician. Part B will cover doctor visits and may help pay for diagnostic testing if your doctor finds it medically necessary.

If you require inpatient hospitalization, your care may be covered by Part A. Even if your memory care facility is a Medicare-participating facility, you will only receive full Medicare benefits for 60 days per benefit period. These are supplied by Medicare Part A, the inpatient benefit. After that, you receive an additional 30 days at a discounted rate. Beyond 90 days, you can use lifetime reserve days to continue inpatient care until lifetime reserve days have been exhausted or until the next benefit period begins.

If you need to move into a residential care facility on a long-term basis, Medicare coverage will not apply unless the facility is a hospital or skilled nursing facility.

Original Medicare and memory care medications

If you are prescribed medications to treat a memory condition, Original Medicare benefits are usually available through Medicare Part D. Not all drugs qualify for coverage under Medicare Part D, so you will want to review your plan’s formulary with your doctor. This formulary lists all covered medications along with their restrictions and coverage limitations.

Medicare Advantage and Special Needs Plans

Some Medicare Advantage plans are deemed Institutional Special Needs Plans (I-SNPs). These plans work much like traditional Medicare Advantage plans in that they provide Medicare benefits for inpatient, outpatient and prescription drug treatments. The difference is that they also include benefits for individuals with certain medical conditions who are housed in a residential assisted living facility for ongoing care.

Some I-SNPs will cover memory care facilities, but this will be up to your plan and plan provider. You can also contact an independent Medicare insurance broker who can impartially shop the market of available Medicare Advantage providers in your area who offer I-SNP plans to find one that meets your needs.

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