Does Insurance Pay for Memory Care?
If you have a loved one with dementia, you know the costs of care can add up quickly. It’s natural to assume insurance will pay for expenses related to memory care, but that’s not always the case. Which expenses insurance covers depends on many factors, including your loved one’s health, their financial status, and their individual policy.
Medicare and Medicaid may help, but Medicaid coverage varies by state, and recipients must adhere to strict rules to qualify. Some people rely on family members to help cover the cost of memory care, but that’s not always an option. Here’s what you need to know about insurance coverage for memory care.
Understanding Insurance Coverage for Memory Care
Private health insurance, VA health benefits, Medicaid, and Medicare typically provide some coverage, but only for services that are deemed medically necessary. Examples of services that are usually covered include:
- Inpatient treatment
- Prescription medications
- Doctor’s appointments and assessments
- Walkers, wheelchairs, and other “durable” medical equipment
- Diagnostic testing needed to confirm cognitive decline
While insurance can help minimize any out-of-pocket costs, neither Medicare nor private health insurance will generally cover long-term care services in your loved one’s home or in a memory care facility.
Services that qualify as custodial care are typically non-medical. Examples include help with household chores, assistance with daily living, and general supervision.
What Type of Insurance Covers the Costs of Memory Care?
Memory care services are provided in a variety of settings, including independent care homes, assisted living facilities, and by a visiting care provider in the individual’s home. Families often have to rely on more than one resource to cover memory care costs.
If you are helping a loved one plan for their future needs, or if you’re planning for your own future care, knowing which insurance plans cover dementia costs can save time and money.
Medicaid
Medicaid is an option for individuals who can’t afford traditional healthcare insurance. Eligibility for the program and coverage vary state by state. It may cover up to 50% of the cost for a Medicaid-approved assisted living facility. So if your loved one needs 24-hour care for late-stage dementia, they may qualify for long-term care through Medicaid.
Medicare
For those who qualify, Medicare covers certain medical items, doctors’ fees, and outpatient prescription medications. It may also cover some inpatient hospital care and some home health care. This can include rehabilitation therapy and skilled nursing care.
However, Medicare will typically not pay for personal in-home care aides or long-term care in a skilled nursing facility.
Long-Term Care Insurance
Depending on the policy, long-term care insurance may cover the cost of dementia care. Not everyone qualifies for long-term care insurance, though. If an individual has already been diagnosed with Alzheimer’s disease or another type of dementia, they cannot purchase long-term care insurance.
Life Insurance
If your loved one has a whole-life policy, they may be able to sell the policy to a third party for a lump-sum payment. The cash value of most life insurance policies is only a fraction of the benefits they would provide upon death, but selling a policy can provide much-needed funds for memory care.
VA Health Care
Eligible veterans may qualify for care in an assisted living facility, adult family home, or other residential care program. VA benefits may also be used to pay for dementia care at a nursing home or in the individual’s private home.
COBRA
If a person who is still working and is under the age of 65 develops dementia, they may qualify for memory care services under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
COBRA allows an insured employee to continue receiving group plan coverage for up to 36 months after they leave their place of employment or no longer qualify for the provided health plan.
Planning for the Future Starts With Exploring Your Options
Planning for the possibility or reality of future dementia care can be emotionally and financially challenging. Understanding the available options for memory care coverage can help ease the stress. If you find yourself with questions, speaking with your insurance agent or consulting with a memory care provider can be invaluable.
If you or your family member is considering in-home care as part of a plan to age in place, contact Family Matters In-Home Care today for a free consultation. Our team is dedicated to supporting your family and helping older adults enjoy life in the comfort of their own home for as long as possible.
Some of the services offered by Family Matter In-Home Care include: Alzheimer’s & Dementia Care, Bed & Wheelchair Transfer Assistance, Companionship, Housekeeping & Meal Preparation, Personal Care, Recovery Care, and Transportation.
Serving the San Francisco Bay Area and Greater San Diego, Family Matter In-Home Care has offices throughout California.
