Dementia, including Alzheimer's disease, vascular dementia, Lewy body dementia and frontotemporal dementia, brings medical needs Medicare covers and long-term care needs it mostly doesn't. Knowing where that line falls helps Oregon families plan.
Diagnosis and assessment
- Yearly Wellness visit: your provider can check for signs of cognitive impairment. You pay nothing for the Wellness visit if your provider accepts assignment.
- Cognitive assessment and care plan visit: Part B covers a separate visit to fully review your cognitive function, establish or confirm a diagnosis such as dementia or Alzheimer's disease, and create a care plan. Bring a family member or caregiver. You pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026; CMS announces 2027 amounts in the fall).
- Diagnostic tests: neurological exams, brain imaging and neuropsychological testing are covered when medically necessary, with the usual Part B cost sharing.
Leqembi and Kisunla
Leqembi (lecanemab) and Kisunla (donanemab) are FDA-approved monoclonal antibodies that target amyloid plaques in early Alzheimer's disease. They're given by infusion, so they're covered under Part B when:
- you have a diagnosis of mild cognitive impairment or mild Alzheimer's dementia, with documented amyloid plaque (for example, by PET scan or spinal fluid test); and
- your doctor participates in a qualifying CMS registry and has an appropriate clinical team and follow-up care, including MRI monitoring for side effects.
With Original Medicare you pay 20% of the Medicare-approved amount for the drug and infusions after the Part B deductible; a Medigap policy can pay that coinsurance. Medicare Advantage plans must cover these drugs too, but costs, networks and prior authorization rules vary by plan.
Other dementia medicines
Pills and patches for dementia symptoms, such as donepezil, rivastigmine, galantamine and memantine, are covered by Part D plans according to each plan's formulary. Covered Part D drug costs are capped at $2,400 in 2027 ($2,100 in 2026).
What Medicare does cover
- Hospital care under Part A.
- Skilled nursing facility care for up to 100 days per benefit period after a qualifying hospital stay of at least three days, when daily skilled care is needed (for example, after a fall or pneumonia).
- Home health care when the person is homebound and needs part-time skilled nursing or therapy.
- Physical, occupational and speech therapy when medically necessary.
- Advance care planning visits under Part B. See end-of-life Medicare in Oregon and POLST in Oregon.
- Hospice under Part A when a doctor certifies a life expectancy of six months or less and comfort care is chosen.
CMS's GUIDE Model (Guiding an Improved Dementia Experience), which started in July 2024, pays participating dementia care programs for care coordination and caregiver support, including some respite. CMS lists the participating programs; ask your doctor whether one serves your area.
What Medicare does not cover
- Memory care or assisted living room and board.
- Long-term nursing home care (custodial care beyond the skilled nursing benefit).
- In-home custodial care, such as help with bathing, dressing and supervision, when that's the only care needed.
- Adult day programs.
- Home changes such as grab bars, ramps or stair lifts.
Some Medicare Advantage plans include in-home support or adult day services as extra benefits. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage. See does Medicare cover memory care in Oregon? and does Medicare cover in-home caregivers?
Help with long-term care in Oregon
- Medicaid long-term care: ODHS Aging and People with Disabilities (the state aging and disability agency) and local Area Agencies on Aging handle Medicaid in-home, community-based and nursing facility care for people who meet the financial and functional rules. Call 1-855-673-2372. See how to qualify for Medicaid long-term care in Oregon.
- Oregon Project Independence: in-home services for people 60 and older, or any age with Alzheimer's disease or a related disorder, who aren't on Medicaid, with fees on a sliding scale. See what is Oregon Project Independence?
- Family caregiver support: Area Agencies on Aging run caregiver support programs that can include respite and training.
- OHP and Medicare together: if the person qualifies for both, see dual eligibility in Oregon.
- Alzheimer's Association helpline: 1-800-272-3900, day and night, for caregiver information.
Choosing coverage
- Original Medicare with Medigap lets you use any neurologist, memory clinic or infusion center that accepts Medicare. Medigap can pay the 20% Part B coinsurance on Leqembi or Kisunla infusions and the MRIs that go with them.
- Medicare Advantage plans use networks and may require prior authorization; check that your neurologist, infusion center and imaging center are covered. Each plan has a yearly in-network out-of-pocket limit (no more than $9,850 in 2027).
- Plan early. Advance directives, POLST, financial powers of attorney and a form letting Medicare talk to a family member are easier to complete before memory loss advances.
To compare plans with your doctors and drugs in mind, you can request a call from a licensed insurance agent, or meet licensed insurance agents in Oregon.
Related guides
Medicare by condition
All condition guides.
POLST in Oregon
Medical orders for serious illness.
Dual eligibility (Medicare and OHP)
How Medicaid helps with long-term care.
Sources
- Medicare.gov — Cognitive assessment and care plan services
- Medicare.gov — Monoclonal antibodies for treating early Alzheimer's disease
- CMS — Broader Medicare coverage of Leqembi following FDA traditional approval
- CMS — GUIDE Model
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Hospice care
- Medicare.gov — Long-term care
- Oregon Department of Human Services — Aging and Disability Services
- OAR 411-032-0020 — Oregon Project Independence eligibility (via Cornell LII)
Frequently asked questions
Does Medicare cover a cognitive assessment for dementia?
Yes. Part B covers a separate cognitive assessment and care plan visit to review your thinking and memory, confirm a diagnosis such as dementia or Alzheimer's disease, and build a care plan. You pay 20% of the Medicare-approved amount after the Part B deductible. Your provider may also check for signs of dementia at your yearly Wellness visit.
Does Medicare cover Leqembi or Kisunla?
Yes, under Part B, if you have mild cognitive impairment or mild Alzheimer's dementia with documented amyloid plaque and your doctor takes part in a qualifying CMS registry. With Original Medicare you pay 20% of the Medicare-approved amount after the Part B deductible.
Does Medicare pay for memory care or assisted living?
No. Medicare doesn't pay for room and board in memory care or assisted living, long-term nursing home care, or help with bathing, dressing and supervision. In Oregon, Medicaid long-term care through ODHS Aging and People with Disabilities can pay for in-home, community-based or nursing facility care for people who qualify.
Does Medicare cover hospice for dementia?
Yes, when a doctor certifies a life expectancy of six months or less and the person chooses comfort care. Hospice can be given at home, in a care facility or in a nursing home; Medicare doesn't pay room and board.
Medicare in your Oregon county
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