What Medicare does cover for dementia
- Cognitive assessment and care plan. Part B covers a visit to check memory and thinking and build a care plan, either during your yearly Wellness visit or at a separate visit.
- Doctor and mental health care, hospital stays and medically necessary tests, with the usual Part A and Part B cost sharing.
- Short-term skilled nursing or home health when you meet Medicare's rules, such as after a hospital stay.
- Hospice when a doctor certifies a life expectancy of six months or less. Hospice covers the care, but not room and board in a facility.
- Prescription drugs through a Part D plan or a Medicare Advantage plan with drug coverage, depending on each plan's formulary.
What Medicare doesn't cover
Medicare doesn't pay for custodial care when it is the only care you need: supervision, help with bathing, dressing and eating, or room and board in a memory care community, assisted living or adult foster home.
How memory care is paid for in Oregon
| Source | What it can pay for |
|---|---|
| Medicaid (OHP long-term care, through ODHS) | Care in an endorsed memory care community, or in-home and other community care, for people who meet income, resource and care-need rules |
| Oregon Project Independence | Limited in-home help for people not on Medicaid, on a sliding fee scale |
| Long-term care insurance | Depends on the policy |
PACE, a Medicare and Medicaid program for people 55 and older who need a nursing home level of care, is available in some Oregon counties.
Steps for families
- Ask for a cognitive assessment. A diagnosis and care plan help with every later decision.
- Call ODHS Aging and People with Disabilities. The state aging and disability agency (1-855-673-2372) can explain Medicaid long-term care, Oregon Project Independence and family caregiver support. Apply for Medicaid at benefits.oregon.gov or 1-800-699-9075.
- Check a community's license. Use the state's long-term care licensing search to confirm a memory care endorsement and see inspection history.
- Review Medicare coverage each fall. Make sure doctors and drugs still work with your coverage; you can request a call from a licensed insurance agent to compare options.
Related questions
Does Medicare cover assisted living in Oregon?
Another long-term care setting.
Does Medicare pay for in-home caregivers in Oregon?
Help at home.
Does Medicare cover nursing home care in Oregon?
Skilled versus custodial care.
How do I qualify for Medicaid long-term care in Oregon?
The ODHS rules.
Sources
- Medicare.gov — Long-term care
- Medicare.gov — Cognitive assessment and care plan services
- Oregon Department of Human Services — OAR chapter 411, division 57, Endorsed memory care communities
- Oregon Department of Human Services — Long-term care
- Oregon Department of Human Services — Oregon Project Independence
More questions in this guide
- Does Medicare cover acupuncture in Oregon?
- Does Medicare cover ambulance service in Oregon?
- Does Medicare cover annual physicals in Oregon?
- Does Medicare cover assisted living in Oregon?
- Does Medicare cover bone density tests in Oregon?
- Does Medicare cover cataract surgery in Oregon?
- Does Medicare cover chiropractic care in Oregon?
- Does Medicare cover a colonoscopy in Oregon?
- Does Medicare cover CPAP machines in Oregon?
- Does Medicare cover dental care in Oregon?
- Does Medicare cover diabetic supplies in Oregon?
- Does Medicare cover flu shots in Oregon?
- Does Medicare cover hearing aids in Oregon?
- Does Medicare cover home health care in Oregon?
- Does Medicare pay for in-home caregivers in Oregon?
- Does Medicare cover mammograms in Oregon?
- Does Medicare cover me when I travel or spend winters outside Oregon?
- Does Medicare cover medical marijuana in Oregon?
- Does Medicare cover mental health care in Oregon?
- Does Medicare cover naturopathic doctors in Oregon?
- Does Medicare cover nursing home care in Oregon?
- Does Medicare cover oxygen therapy in Oregon?
- Does Medicare cover physical therapy in Oregon?
- Does Medicare cover prostate cancer screening in Oregon?
- Does Medicare cover psilocybin therapy in Oregon?
- Does Medicare cover skilled nursing care in Oregon?
- Does Medicare cover the shingles vaccine in Oregon?
- Does Medicare cover transportation to medical appointments in Oregon?
- Does Medicare cover vision care in Oregon?
- Does Medicare cover wheelchairs in Oregon?
Part of the guide: Learn Medicare — the Oregon starter guide · All questions
Frequently asked questions
What is an endorsed memory care community in Oregon?
It is a licensed nursing facility, residential care facility or assisted living facility that ODHS has also endorsed to run a secured unit for people with Alzheimer's or other dementia. In Oregon, a community can't advertise as memory care without that endorsement.
Does Medigap or long-term care insurance pay for memory care?
Medigap doesn't; it only helps with costs Medicare covers. A private long-term care insurance policy may pay, depending on its terms, so read the policy or ask the company.
Is there help at home for someone with dementia who isn't on Medicaid?
Yes. Oregon Project Independence offers limited in-home help, on a sliding fee scale, to people 60 and older and to people of any age with Alzheimer's or a related disorder who aren't on Medicaid.
Medicare in your Oregon county
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