Medicare Coverage for Alzheimer's Disease and Dementia

Alzheimer's disease affects approximately 6.5 million Americans -- and the majority are Medicare beneficiaries. Dementia creates complex, evolving care needs that span years or decades. Understanding what Medicare covers -- and where the gaps are -- is essential for families navigating this diagnosis.

Annual Wellness Visit: Medicare covers cognitive impairment detection as part of the Annual Wellness Visit at no cost. Your doctor will assess your cognitive function using a brief screening tool.

Cognitive assessment: If cognitive impairment is suspected, Medicare covers a comprehensive cognitive assessment -- including a detailed evaluation of cognitive function, functional ability, and safety -- at no cost.

Diagnostic workup: When dementia is suspected, Medicare covers the diagnostic evaluation under Part B:

• Neurological examination
• Neuropsychological testing
• Brain imaging (MRI, CT, PET scan) when medically indicated
• Laboratory tests to rule out reversible causes

Medicare Part D covers FDA-approved Alzheimer's medications:

Cholinesterase inhibitors (for mild to moderate Alzheimer's):

• Donepezil (Aricept) -- generic available
• Rivastigmine (Exelon) -- generic available
• Galantamine (Razadyne) -- generic available

NMDA receptor antagonist (for moderate to severe Alzheimer's):

• Memantine (Namenda) -- generic available
• Donepezil/memantine combination (Namzaric)

Lecanemab (Leqembi) and donanemab (Kisunla): Newer amyloid-targeting therapies for early Alzheimer's. Medicare covers these drugs for beneficiaries enrolled in qualifying clinical studies or who meet specific criteria. Coverage and cost-sharing continue to evolve -- check with your plan.

For beneficiaries with Alzheimer's or dementia as a chronic condition, Medicare covers Chronic Care Management (CCM) -- monthly care coordination services provided by your doctor's office:

• Development and maintenance of a comprehensive care plan
• Coordination between providers
• 24/7 access to care team for urgent needs
• Medication management

Cost: 20% coinsurance after the Part B deductible. Medigap Plan G covers this 20%.

Medicare covers a dedicated care planning visit for beneficiaries with cognitive impairment -- to develop or update a care plan addressing:

• Safety concerns (driving, wandering, medication management)
• Caregiver needs and support
• Advance care planning
• Community resources

Homebound beneficiaries with dementia can receive Medicare home health services:

• Skilled nursing visits
• Physical, occupational, and speech therapy
• Home health aide services (when skilled care is also provided)
• Social worker services

Medicare does not cover adult day services -- structured daytime programs providing supervision, activities, and social engagement for people with dementia. However, some Medicare Advantage plans include adult day benefits as a supplemental benefit.

Medicare's most significant limitation for dementia patients is long-term custodial care. Medicare does not cover:

• Memory care units in assisted living facilities
• Long-term nursing home care (beyond 100 days of skilled care)
• 24-hour supervision at home

These costs -- which can reach $50,000-$100,000+ per year -- must be paid out of pocket, through long-term care insurance, or through Medicaid (after spending down assets).

Planning recommendation: If you or a family member has early-stage dementia, consult an elder law attorney about Medicaid planning and asset protection strategies while options are still available.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.