Medicare is the main health insurance for most Americans age 65 and older. When someone has dementia, Medicare pays for a lot of medical care: doctor visits, memory testing, hospital stays, short-term home health, and hospice near the end of life.

But many families are surprised by what it does not pay for. Medicare does not pay for long-term help with daily life, such as bathing, dressing, meals and supervision. That kind of care is often the biggest cost in dementia. This page explains both sides, so you can plan ahead.

Key points

Medicare covers a memory check at the yearly Wellness visit and a longer cognitive assessment and care plan visit.^1,2
The Medicare GUIDE program offers a care navigator, a 24/7 support line, caregiver training and up to $2,500 a year for respite, at no cost to you. Only some clinics take part, and only people with Original Medicare can join.^3,4
Home health and skilled nursing are covered only for short-term skilled care, not for ongoing daily help.^6,7
Hospice is covered when a doctor expects life to last 6 months or less.⁵
Medicare does not pay for long-term custodial care at home, in assisted living or in a nursing home. Medicaid, long-term care insurance or your own money usually pay for it.⁸

A quick map of Medicare

Medicare has a few parts. Knowing them makes the rest of this page easier.

Part	What it mainly covers	2026 costs to know
Part A (hospital)	Hospital stays, short skilled nursing stays, hospice, some home health	$1,736 deductible for each hospital benefit period⁹
Part B (medical)	Doctor visits, tests, outpatient care, home health, medical equipment	$202.90 a month standard premium, $283 yearly deductible, then usually 20%⁹
Part D (drugs)	Prescription drugs you fill at a pharmacy	Out-of-pocket costs for covered drugs capped at $2,100 in 2026¹⁰
Medicare Advantage (Part C)	Private plans that replace Original Medicare	Costs and rules depend on the plan¹³

Original Medicare means Parts A and B run by the government. Many people add a Medigap policy (Medicare Supplement Insurance) to help pay the 20% share and deductibles.¹³

Memory checks and diagnosis

The yearly Wellness visit

Medicare Part B covers a yearly "Wellness" visit once every 12 months. It is a planning visit, not a full physical exam. During this visit, the provider checks for signs of memory or thinking problems, including Alzheimer's disease.¹

You pay nothing for the Wellness visit itself if the provider accepts Medicare's rates. If other tests or care are added on the same day, you may owe a share for those.¹ This visit is also a good time to bring up advance directives. See advance directives.

The cognitive assessment and care plan visit

If the doctor suspects a problem, Medicare covers a separate, longer visit to look more closely. It can help find or confirm a diagnosis such as Alzheimer's disease. During this visit, the provider may:²

Do an exam, review health history and go over all medicines
Ask who helps at home, including what the main caregiver can do
Write a care plan for managing symptoms
Help start or update an advance care plan
Refer you to a specialist if needed
Share local resources, such as adult day programs and support groups

This visit falls under Part B, so you usually pay 20% after the deductible.² Bring a family member or friend to help listen and ask questions. If the doctor does not bring it up, you can ask for this visit by name. See the first doctor visit about memory for what to bring.

Tests, scans and medicines

Part B helps pay for doctor and specialist visits and outpatient care. Part D helps pay for many prescription drugs.¹³ Part B can cover the newer anti-amyloid drugs for early Alzheimer's when strict medical rules are met.¹³ Learn more in brain scans and paying for new Alzheimer's drugs.

Depression and anxiety are common in dementia. Medicare also covers mental health care. See what Medicare covers for mental health.

The GUIDE program: dementia support from Medicare

GUIDE stands for Guiding an Improved Dementia Experience. It is a Medicare test program that began on July 1, 2024. It is planned to run for eight years.³ As of October 2026, nearly 300 programs across the country take part.³

A GUIDE care team can offer:³

A care navigator, one person who helps you find your way through care
A 24/7 support line for questions and hard moments
Caregiver training and education
Respite, short breaks for the caregiver, at home, at an adult day center or in a facility, up to $2,500 per person each year (the amount is adjusted for inflation)⁴
Help with needs like meals and rides, and links to local services

What it costs. GUIDE programs cannot charge you for GUIDE services, including respite.⁴

Who can join. All of these must be true:⁴

A GUIDE clinician confirms the dementia diagnosis.
The person has Medicare Parts A and B, and Medicare is their main insurance.
They are not in a Medicare Advantage plan (including Special Needs Plans) or in PACE.
They have not chosen hospice.
They live at home, or in a residential care community that partners with the GUIDE program. People who live long-term in a nursing home cannot join. As of July 2026, people living in memory care units cannot join either.

People in a partner residential care community cannot get GUIDE respite, but their caregivers can still get education and support.⁴ Taking other Alzheimer's medicines does not keep you out.⁴

How to find a program. Only certain clinics and health systems take part. CMS posts a list of GUIDE programs on its website. Contact one near you and ask for an assessment. The care team then asks Medicare to confirm that you qualify.⁴ You can also ask your doctor or call 1-800-MEDICARE (1-800-633-4227).

More on caregiver support is in caregiver training and support programs.

Home health care

Medicare covers home health care when a doctor orders it and a Medicare-certified agency provides it. The person must be homebound and need part-time skilled care.⁶

"Homebound" means leaving home is hard and takes a lot of effort, or the person can only leave with help from another person or a device. Short trips to the doctor, to religious services or to adult day care are allowed.⁶ Someone with moderate or late dementia who cannot safely go out alone may meet this rule. Ask the doctor.

Covered home health services include:⁶

Part-time skilled nursing, such as wound care or teaching about medicines
Physical, occupational and speech therapy
Medical social services
A home health aide for bathing or dressing, but only while skilled nursing or therapy is also needed

You pay nothing for covered home health visits. Medical equipment, like a walker or hospital bed, usually costs 20% after the Part B deductible.⁶

Medicare home health does not cover 24-hour care, meal delivery, housekeeping or personal care when that is the only help needed.⁶ When the skilled need ends, the aide visits end too. Learn the difference between home health and home care in in-home care.

Hospital and short nursing home stays

Part A covers hospital stays. After a hospital stay, Part A may also cover a short stay in a skilled nursing facility (a nursing home that gives rehab or daily skilled care).⁷

The rules are strict:⁷

The person must have been admitted to the hospital for at least 3 days in a row. Time "under observation" or in the emergency room does not count, even overnight.
They usually must enter the facility within 30 days of leaving the hospital.
They must need daily skilled nursing or therapy.

What you pay in 2026, per benefit period:⁷

Days	Your share
1–20	$0 (after the Part A deductible)
21–100	$217 a day
101 and beyond	All costs

During any hospital stay, ask: "Is my family member admitted, or under observation?" Only admitted days count toward the 3 days needed for skilled nursing coverage.⁷

Coverage can end before day 100 if the person no longer needs daily skilled care.⁷ If they stay in the nursing home after that, the family pays, or Medicaid may help.

Hospice care

Medicare Part A covers hospice for people who are expected to live 6 months or less if the illness runs its usual course. A hospice doctor and the regular doctor must certify this. The person chooses comfort care instead of treatment aimed at curing the illness.⁵

Hospice can be given at home, in assisted living or in a nursing home. It covers the services in the hospice care plan, including medicines for pain and other symptoms.⁵ Costs to you are small:⁵

$0 for hospice care
Up to $5 for each prescription for pain and symptom medicines
5% of the Medicare-approved amount for short inpatient respite stays that give the caregiver a break

Hospice is given in two 90-day periods, then any number of 60-day periods. The hospice doctor must recertify that the person still qualifies.⁵

What hospice does not cover: room and board at home, in a nursing home or in assisted living.⁵ Families who pay for a care home still pay that bill while on hospice. For dementia-specific eligibility and what to expect, see hospice care for dementia.

What Medicare does NOT cover

This is the most important part to plan for. Medicare does not pay for long-term custodial care, which is mostly non-medical help with daily life.⁸ This includes:⁸

Help with bathing, dressing, eating and using the toilet
Supervision so the person stays safe
Long-term stays in a nursing home or memory care
Assisted living
Adult day health care
Home-delivered meals and rides

Most Medigap policies do not pay for this care either.⁸ Many people with dementia need this kind of help for years. That is why dementia care can cost so much. See what dementia care costs.

Do not count on Medicare to pay for a nursing home or memory care. Medicare covers at most 100 days of skilled care after a hospital stay, and sometimes less. Long-term stays are paid by the family, long-term care insurance, VA benefits or Medicaid.^7,8

Who pays for long-term care, then?

Medicaid may pay for long-term care if the person meets the state's income and savings rules. Read Medicaid and long-term care.⁸
Long-term care insurance may pay if a policy was bought earlier. See long-term care insurance.⁸
VA benefits may help veterans and surviving spouses. See VA benefits for dementia.
PACE combines Medicare and Medicaid into one program for some older adults who live at home. See PACE.

Help with Medicare costs

If money is tight, your state may help through Medicare Savings Programs. Depending on income, they can pay the Part B premium, and the most complete program also pays deductibles and the 20% share. People in most of these programs also get Extra Help with drug costs. In 2026, Extra Help limits drug copays to no more than $12.65 per drug.¹¹ You apply through your state Medicaid office. Apply even if you are not sure you qualify, since states count income differently.¹¹

Original Medicare or Medicare Advantage?

Medicare Advantage plans are run by private companies. They may add extras like dental or vision. But they usually limit which doctors and hospitals you can use, so check that the person's doctors are in the plan.¹³ Some are Special Needs Plans designed for people living with dementia.¹³

Keep in mind that people in Medicare Advantage cannot join GUIDE.⁴

Each year, Open Enrollment runs October 15 to December 7. During this time you can switch between Original Medicare and Medicare Advantage or change drug plans. Changes start January 1.¹² If you are already in a Medicare Advantage plan, you get another chance from January 1 to March 31.¹²

In Virginia, the Virginia Insurance Counseling and Assistance Program (VICAP) gives free, unbiased Medicare counseling through local Area Agencies on Aging.¹⁴ A counselor can compare plans with you and explain what a switch could mean for your Medigap options. In other states, look for your SHIP (State Health Insurance Assistance Program).

Common questions

Does Medicare pay for adult day care?

No. Medicare lists adult day health care as long-term care, which it does not cover.⁸ Medicaid waivers, VA benefits and GUIDE respite (for eligible people) may help.³ See adult day care.

Will Medicare pay for memory care or assisted living?

No. Medicare does not pay for room, board or daily help in memory care or assisted living.⁸ It still pays for covered medical care, such as doctor visits and hospice, while the person lives there.⁵

Can we use GUIDE and hospice at the same time?

No. People who have chosen hospice cannot join GUIDE.⁴ Hospice brings its own team and support for caregivers.⁵

Sources

Centers for Medicare & Medicaid Services. Yearly "Wellness" visits. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Cognitive assessment & care plan services. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Guiding an Improved Dementia Experience (GUIDE) Model. CMS Innovation Center, updated 2026. CMS
Centers for Medicare & Medicaid Services. GUIDE Model frequently asked questions. CMS Innovation Center, 2026. CMS
Centers for Medicare & Medicaid Services. Hospice care. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Home health services. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Skilled nursing facility care. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Long-term care. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Medicare costs. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Catastrophic coverage. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Medicare Savings Programs. Medicare.gov, 2026. Medicare.gov
Centers for Medicare & Medicaid Services. Joining a plan. Medicare.gov, 2026. Medicare.gov
Alzheimer's Association. Medicare. Alzheimer's Association, 2026. alz.org
Virginia Department for Aging and Rehabilitative Services, Division for Aging Services. Virginia Insurance Counseling and Assistance Program (VICAP). 2026. vda.virginia.gov

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.