Medicare covers a broad range of services for people diagnosed with Alzheimer's disease or another form of dementia, but the coverage has clear limits. Understanding what Parts A, B, and D pay for, what's excluded, and which newer programs can fill gaps helps families plan realistically for the road ahead.
What Medicare Covers for Alzheimer's and Dementia
Medicare coverage for dementia falls across three parts, each handling a different category of care.
Medicare Part A: Hospital and Skilled Nursing
Part A covers inpatient hospital stays when a person with dementia needs acute care. This includes hospital room and board, nursing care, medications administered during the stay, and some physical or occupational therapy.
Part A also covers short-term skilled nursing facility (SNF) care after a qualifying hospital stay of at least three days. For example, if someone with Alzheimer's is hospitalized for a fall or infection and then needs rehabilitation, Medicare will cover the SNF stay up to certain limits.
2026 Part A Cost-Sharing:
| Service | What You Pay |
|---|
| Hospital stay (days 1-60) | $1,736 deductible per benefit period |
| Hospital stay (days 61-90) | $433 per day |
| Skilled nursing facility (days 1-20) | $0 |
| Skilled nursing facility (days 21-100) | $216.50 per day |
| Skilled nursing facility (beyond day 100) | Full cost |
Part A does not cover long-term custodial care in a nursing home when the primary need is help with daily activities rather than skilled medical treatment. This is one of the most important gaps for dementia families to understand.
Medicare Part B: Outpatient and Diagnostic Services
Part B covers the broad range of outpatient services most relevant to an Alzheimer's or dementia diagnosis:
- Physician visits and specialist consultations
- Cognitive assessments and annual wellness visits that include cognitive screening
- Laboratory tests (blood work, neurological exams)
- Brain imaging including MRI and CT scans
- Beta-amyloid PET scans for diagnosing Alzheimer's (coverage expanded in 2023 and continues in 2026, with patients paying 20% after meeting the Part B deductible)
- Mental health services including psychiatric care and counseling
- Occupational therapy, speech therapy, and physical therapy
- Durable medical equipment such as walkers and hospital beds for home use
- Home health services when skilled nursing or therapy is medically necessary
2026 Part B Costs:
| Item | Amount |
|---|
| Monthly premium | $202.90 |
| Annual deductible | $283 |
| Coinsurance after deductible | 20% of Medicare-approved amount |
If your income is above $109,000 (single) or $218,000 (married filing jointly), you will pay an IRMAA surcharge on top of the standard premium.
Part B covers care planning for Alzheimer's and other dementias. This means your doctor can bill Medicare for time spent creating a care plan, coordinating with specialists, and reviewing medications specifically related to a dementia diagnosis.
Medicare Part D: Prescription Drugs
Part D covers prescription medications, including drugs used to treat Alzheimer's symptoms. Every Medicare Part D plan is required to cover at least two drugs in the Alzheimer's treatment category. Common covered medications include cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine.
A major change in 2026 is the new $2,100 annual out-of-pocket cap on prescription drugs. Once you spend $2,100 in covered Part D costs in a calendar year, you pay nothing for covered drugs for the rest of the year. This is a significant relief for people managing multiple prescriptions.
New Alzheimer's Drugs: Leqembi and Kisunla
Two newer drugs, Leqembi (lecanemab) and Kisunla (donanemab), target the underlying disease process by reducing amyloid plaques in the brain. Both have received full FDA approval and Medicare covers them under Part B.
Coverage requires enrollment in a CMS-approved registry. Your prescribing physician must participate in data collection as part of a coverage with evidence development (CED) requirement. Most major academic medical centers and memory clinics are set up to facilitate this.
If you qualify and your doctor participates, you pay 20% of the drug cost after meeting the Part B deductible. Leqembi's list price is approximately $26,500 per year, which means the 20% coinsurance can be substantial without supplemental coverage. Medigap or Medicaid may help cover this cost depending on your situation.
Eligibility for these drugs generally requires early symptomatic Alzheimer's disease and confirmed amyloid plaque presence through a PET scan or spinal fluid test.
The GUIDE Program: Free Dementia Care Coordination
One of the most significant newer developments for Medicare beneficiaries with dementia is the GUIDE (Guiding an Improved Dementia Experience) model, which launched in July 2024 and runs as an eight-year pilot program through CMS.
GUIDE covers services that traditional Medicare does not, at no cost to the beneficiary:
- Comprehensive, person-centered care planning
- Ongoing care coordination across providers
- 24/7 access to a dementia-trained care team member or helpline
- Caregiver education and support
- Up to $2,500 per year in respite care services
To be eligible, you must have a clinician-confirmed dementia diagnosis (or be referred for memory evaluation) and be enrolled in traditional Medicare Parts A and B. GUIDE is not available to Medicare Advantage or PACE enrollees.
Not every area of the country has a GUIDE-participating provider yet, but the program is expanding. The Alzheimer's Association maintains a directory of participating sites.
What Medicare Does NOT Cover
Several types of care commonly needed by people with dementia fall outside Medicare's coverage:
- Long-term custodial care in a nursing home (assistance with bathing, dressing, eating when no skilled medical care is needed)
- Assisted living facility room and board
- Memory care unit fees in assisted living or residential care settings
- Adult day care (in most cases)
- Personal care aides at home who provide companionship or help with daily tasks without skilled nursing or therapy
These exclusions represent significant costs. A private room in a nursing home averages over $100,000 per year nationally. Families often need to plan separately for these expenses through long-term care insurance, personal savings, or Medicaid.
Medicaid for Long-Term Dementia Care
Medicaid, not Medicare, covers custodial long-term care for people who meet income and asset requirements. Many people spend down their assets over time until they qualify for Medicaid, at which point the program covers nursing home costs.
Millions of Americans are dually eligible for both Medicare and Medicaid. For dual-eligible individuals, Medicare typically pays for medical services while Medicaid covers long-term care and may also cover premiums, deductibles, and copayments that would otherwise come out of pocket.
Medicare Savings Programs: Reducing Your Costs
If your income is limited, Medicare Savings Programs (MSPs) can pay your Part B premium, deductibles, and copayments. This is especially valuable when you are managing ongoing dementia-related care costs.
2026 Medicare Savings Program Income Limits (most states):
| Program | Individual Monthly Income | Couple Monthly Income | Benefit |
|---|
| QMB (Qualified Medicare Beneficiary) | Up to $1,350 | Up to $1,824 | Pays Part A and B premiums, deductibles, coinsurance, and copays |
| SLMB (Specified Low-Income Medicare Beneficiary) | Up to $1,616 | Up to $2,184 | Pays Part B premium only |
| QI (Qualifying Individual) | Up to $1,816 | Up to $2,455 | Pays Part B premium (first-come, first-served) |
2026 Asset Limits for Medicare Savings Programs (most states):
| Status | Asset Limit |
|---|
| Individual | $9,950 |
| Couple | $14,910 |
Some states have higher asset limits or no asset test at all. California, for example, allows up to $130,000 in assets for an individual. Alaska and Hawaii have higher income limits than the figures above.
Enrolling in a Medicare Savings Program also automatically qualifies you for Extra Help (Low Income Subsidy) on Part D, which reduces prescription drug costs significantly.
How to Apply for Medicare Coverage and Assistance
If you or a family member has been diagnosed with Alzheimer's or another dementia, here are the steps to make sure you have the right coverage in place:
Step 1: Confirm Medicare enrollment. If you are 65 or older and have worked enough quarters, you are likely already eligible for Medicare. Enroll through the Social Security Administration at ssa.gov or call 1-800-772-1213.
Step 2: Add a Part D plan. If you only have Original Medicare (Parts A and B), enroll in a standalone Part D drug plan during open enrollment (October 15 to December 7 each year) or during your initial enrollment period. Compare plans at medicare.gov/plan-compare.
Step 3: Consider a Medigap (supplemental) policy. A Medigap plan pays some or all of the 20% coinsurance that Part B leaves to you. This is particularly valuable if you expect high medication costs or frequent specialist visits.
Step 4: Ask your doctor about the GUIDE program. If you have a confirmed dementia diagnosis and use traditional Medicare, ask your neurologist or primary care doctor whether they participate in the GUIDE model. If not, ask for a referral to a participating clinic.
Step 5: Apply for a Medicare Savings Program. If your income and assets are within the limits above, apply through your state Medicaid agency. The application is often the same form as Medicaid, and eligibility is determined at no cost.
Step 6: Request a care planning visit. Under Medicare Part B, your doctor can conduct a separate, billable care planning visit specifically for dementia. Ask for this service if it has not been offered. It covers reviewing medications, coordinating with specialists, and creating a written care plan.
Step 7: Check eligibility for Extra Help on prescriptions. If your income is up to 150% of the federal poverty level (approximately $22,590 per year for a single person in 2026), you likely qualify for the Extra Help program, which substantially lowers Part D premiums and copayments.
Medicare Advantage and Dementia Care
Medicare Advantage plans (Part C) provide all the benefits of Original Medicare through a private insurer, and many include additional benefits such as dental, vision, hearing, and sometimes meal delivery or transportation. Some Medicare Advantage plans have added dementia-specific care management programs.
However, there are trade-offs. Medicare Advantage plans typically use provider networks, which may limit your access to specialist neurologists or memory care centers. Referrals may be required. The GUIDE model is not available to Medicare Advantage enrollees, which is a meaningful limitation for people with dementia who could benefit from free care coordination.
Before choosing or staying on Medicare Advantage, compare whether the additional benefits outweigh the network restrictions for your specific situation.
Planning Ahead: Long-Term Care Considerations
Medicare covers acute and skilled care well but leaves the largest long-term care costs uncovered. Families planning for Alzheimer's or dementia should consider:
- Long-term care insurance, ideally purchased before a diagnosis, to cover nursing home or assisted living costs
- Medicaid planning, which may involve strategies to preserve spousal assets while qualifying the ill spouse for Medicaid coverage
- Veterans benefits, if the person with dementia is a veteran. The VA provides home-based care, adult day care, and long-term care services that can supplement Medicare
A certified elder law attorney or financial advisor who specializes in aging can help with Medicaid planning and asset protection.
Frequently Asked Questions
Does Medicare cover memory care facilities?
No. Medicare does not cover the room and board costs of assisted living memory care units. Medicare may cover skilled nursing or therapy services provided within such a facility if they are medically necessary, but the facility fees themselves are not covered. Medicaid covers long-term nursing home care for those who qualify.
Does Medicare cover in-home help for someone with Alzheimer's?
Medicare covers skilled home health services such as nursing visits, physical therapy, and occupational therapy when they are medically necessary and ordered by a doctor. It does not cover a home health aide who provides only personal care or companionship without a skilled service component. The GUIDE program adds some free respite care for eligible beneficiaries.
What is the annual out-of-pocket cap for Part D in 2026?
The Part D out-of-pocket cap is $2,100 in 2026. Once you reach this threshold in covered drug costs, you pay $0 for the rest of the year for covered medications.
Does Medicare cover amyloid PET scans for Alzheimer's diagnosis?
Yes. Medicare Part B covers beta-amyloid PET scans for diagnosing dementia when ordered by a physician. You pay the standard 20% coinsurance after meeting the $283 Part B deductible.
Can I get help paying my Medicare premiums if I have low income?
Yes. Medicare Savings Programs pay some or all of your Medicare premiums and cost-sharing if your income falls within the limits. For 2026, single individuals with monthly income up to $1,350 may qualify for the QMB program, which covers premiums, deductibles, and copays for both Part A and B.
Are Leqembi and Kisunla covered by Medicare?
Both drugs are covered by Medicare Part B for people with early Alzheimer's disease who meet clinical criteria, including confirmed amyloid plaques. Your prescribing physician must enroll in a CMS-approved data registry. You will pay approximately 20% of the drug cost after your Part B deductible unless you have supplemental coverage.
What is the GUIDE program and how do I access it?
GUIDE is a free Medicare pilot program for people with dementia that covers care coordination, 24/7 support, and up to $2,500 per year in respite care. It requires a dementia diagnosis and traditional Medicare enrollment (not Medicare Advantage). Contact your neurologist or memory care clinic to ask about participating providers, or visit the Alzheimer's Association's GUIDE program page.
Use our free benefits screener to check whether you may qualify for Medicare Savings Programs, Extra Help on prescription drugs, Medicaid, or other assistance programs based on your income and household situation. The screening takes a few minutes and covers 11 programs at once.
