Medicare Coverage for Alzheimer's and Dementia Care: What's Covered in 2026

Frequently Asked Questions

Does Medicare cover Alzheimer's care?

Yes — Medicare covers many aspects of Alzheimer's and dementia care including diagnostic evaluations, doctor visits, medications, hospital care, short-term skilled nursing care, and home health services. However, Medicare does not cover long-term custodial care (the daily supervision and personal care that people with advanced dementia need most), which is primarily covered by Medicaid for those who qualify.

Does Medicare cover memory care facilities?

No — Medicare does not cover residential memory care facilities as a long-term benefit. Medicare covers short-term skilled nursing care (up to 100 days) after a qualifying hospital stay. Long-term memory care facility costs ($5,000–$8,000/month) must be paid out of pocket or through Medicaid for those who qualify financially.

Does Medicare cover the Alzheimer's drug lecanemab (Leqembi)?

Yes — Medicare covers lecanemab (Leqembi) for patients with early-stage Alzheimer's who meet specific criteria, including having a confirmed amyloid-positive diagnosis and no certain contraindications. Coverage requires administration in a clinical setting with monitoring. A prior authorization process applies.

What is the Medicare cognitive impairment benefit?

Medicare Part B covers cognitive impairment assessment as part of the Annual Wellness Visit at no cost. When cognitive impairment is detected, Medicare covers a comprehensive cognitive assessment by a specialist. This benefit is critically underused — fewer than 20% of eligible seniors receive cognitive screening through Medicare.

How do families pay for Alzheimer's care?

Families typically pay for Alzheimer's care through a combination of: Medicare (for acute care and short-term skilled nursing), personal savings and assets, long-term care insurance (if purchased before diagnosis), and eventually Medicaid after assets are spent down to eligibility thresholds. Veterans may also have VA benefits for dementia care.

Alzheimer's disease affects nearly 7 million Americans — and the number is projected to double by 2050. For families navigating a diagnosis, understanding exactly what Medicare covers and what it doesn't is not just financially important — it is essential for planning care that protects the person with dementia and prevents financial devastation for the entire family.

$360K

Average lifetime cost of Alzheimer's care per person — making it one of the most expensive chronic conditions in America, with much of the cost not covered by Medicare

What Medicare Covers: Diagnosis and Evaluation

Medicare Part B covers the diagnostic process for Alzheimer's and dementia:

Annual Wellness Visit with cognitive assessment: Free, no copay — every Medicare beneficiary is entitled to a cognitive assessment annually. This is the most common first step in dementia detection.
Comprehensive cognitive assessment: Covered when your primary care doctor identifies cognitive concerns and refers you to a neurologist or geriatric psychiatrist for a full evaluation.
Brain imaging (MRI, PET scan): Covered when ordered by your doctor to evaluate cognitive decline. Medicare covers amyloid PET scans for patients who meet specific criteria for new Alzheimer's drugs.
Laboratory tests: Blood tests to rule out other causes of cognitive symptoms (thyroid dysfunction, B12 deficiency, etc.) are covered under Part B.
Genetic testing (ApoE4): Not routinely covered by Medicare — only in specific clinical contexts.

What Medicare Covers: Medications

Medicare Part D covers Alzheimer's medications including cholinesterase inhibitors (donepezil/Aricept, rivastigmine/Exelon, galantamine/Razadyne) and memantine (Namenda). These drugs manage symptoms but do not stop disease progression.

Lecanemab (Leqembi) and donanemab: These newer disease-modifying drugs that actually target amyloid plaques are now covered by Medicare for early-stage Alzheimer's patients who meet specific criteria. Coverage requires regular monitoring including MRI scans for ARIA (amyloid-related imaging abnormalities). The drugs cost over $26,000/year — Medicare coverage is essential for most patients.

What Medicare Covers: Ongoing Care

Doctor and Specialist Visits

Part B covers neurologist visits, psychiatrist visits, and primary care follow-up at standard 80/20 cost-sharing. People with Alzheimer's typically require more frequent medical visits — budgeting for Part B coinsurance is important.

Hospital Care

Part A covers inpatient hospitalizations for Alzheimer's-related complications (falls, infections, behavioral crises). The same cost-sharing applies as for any hospitalization.

Home Health Care

Medicare covers skilled home health services for people with dementia who are homebound and require skilled nursing or therapy. A person with Alzheimer's may qualify if they need wound care, medication management, or physical/occupational therapy — and if leaving home requires considerable effort. Home health aides are covered only when concurrent skilled care is also needed.

Short-Term Skilled Nursing

After a qualifying 3-day hospital stay, Medicare covers up to 100 days of skilled nursing facility care — days 1–20 at $0, days 21–100 at $209.50/day in 2026. This can be valuable following a hospitalization for a fall, infection, or behavioral episode.

Critical Gaps: What Medicare Does NOT Cover

This is where families are most often caught off guard:

Adult day care (daily supervision programs) — not covered by Medicare
Memory care facilities (residential care for people with dementia) — not covered as a long-term benefit
In-home companionship or supervision when no skilled medical need exists
Help with daily activities (bathing, dressing, meals, medication reminders) when that is the only need
24-hour home care
Caregiver respite (except under hospice benefit)

💡 The PACE Program

Program of All-inclusive Care for the Elderly (PACE) is an often-overlooked option that provides comprehensive care including adult day care, meals, transportation, and medical care — covered by Medicare and Medicaid for dual-eligible seniors. PACE is available in many states and keeps people with dementia in the community longer. Find your local PACE at npaonline.org.

Planning Ahead: What Families Must Do Early

The window for financial and legal planning narrows quickly after a dementia diagnosis. These steps must be taken while the person with dementia still has decision-making capacity:

Establish Durable Power of Attorney for finances — allows a trusted person to manage money if the person with dementia can no longer do so
Establish Healthcare Power of Attorney / Healthcare Proxy — designates who makes medical decisions
Create or update an Advance Directive (living will)
Consult an elder law attorney about Medicaid planning — to protect some assets while planning for potential nursing home costs
Contact your local Area Agency on Aging for community support services
Explore PACE program eligibility for dual-eligible (Medicare + Medicaid) seniors
Research caregiver support through the Alzheimer's Association: alz.org, helpline 1-800-272-3900