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What Can You Expect Medicare to Cover When a Senior Has Dementia?

December 23, 2019


In addition to all the difficult changes and behaviors that occur when a senior has dementia, families also face the challenge of dealing with the financial aspects of the disease. Dementia requires a great deal of care, which can be quite expensive. Medicare will cover some aspects of the senior’s care, but not everything. When an older adult is diagnosed with dementia, it’s a good idea for family caregivers to familiarize themselves with what is covered, so they can plan for care now and in the future. 

What Medicare Covers 

Let’s start with the good news of what Medicare does cover. Medicare offers benefits to help pay for any medically necessary care. However, what you may think of as medically necessary and what is covered under Medicare’s definition might be two different things. The Centers for Medicare & Medicaid Services (CMS) uses the following definition to determine what is covered: 

“Medically Necessary: Services or supplies that: are proper and needed for the diagnosis or treatment of your medical condition, are provided for the diagnosis, direct care, and treatment of your medical condition, meet the standards of good medical practice in the local area, and aren't mainly for the convenience of you or your doctor.” 

This means that you can reasonably expect most visits to the doctor, laboratory tests, and some care from specialists to be covered. If the older adult has Medicare Part D, some prescription drugs may also be covered. Some other things that Medicare covers include: 

  • Inpatient hospital care. 

  • Up to 100 days of skilled nursing home care in some circumstances. 

  • Hospice care for those the doctor has deemed as being near the end of their life. 

  • Annual wellness checkup.  


The best way to know what is covered and what is not is by contacting a Medicare representative to ask questions. You may also be able to get help through services offered by your local Agency on Aging.  

What It Doesn’t 

Medicare does not cover the day to day custodial care older adults with dementia need. This means that it won’t cover the costs associated with helping the senior manage day to day tasks, like getting dressed or making meals. It also does not cover the cost of a long-term care facility. 

Elderly Care an Affordable Alternative to a Care Facility 

While the cost of elderly care is not covered by Medicare, it can still be an affordable option for ensuring your aging relative receives the best possible care. Elderly care is a less expensive option than placing the older adult in a long-term care facility. Plus, many seniors want to remain at home, so elderly care allows you to honor their wishes.  


If you or your loved one is looking for Elderly Care in Redwood City, CA, please call Familiar Surroundings Home Care. 

Santa Clara County: (408) 979-9990  

San Mateo County: (650) 353-9777 

Santa Cruz County: (831) 480-3990 








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