Does Medicare Cover Home Healthcare for Dementia?
Key takeaways:
Original Medicare provides limited coverage for home healthcare services for individuals with dementia. This includes some skilled nursing care and therapy services if medically necessary. You may have access to more home healthcare services for dementia with a Medicare Special Needs Plan.
For you to qualify for home healthcare with Medicare, a physician must certify that you are homebound. This means you require part-time or intermittent skilled nursing services.
The Program of All-Inclusive Care for the Elderly, known as PACE, offers comprehensive medical and social services. It helps eligible older adults with dementia access more extensive home healthcare.
Medicare covers dementia care, including limited home healthcare, for eligible enrollees. Qualifying for the home healthcare portion of this benefit means you are homebound.
Dementia is a progressive condition that affects one’s ability to care for themselves. There is no cure. Someone with dementia may need in-residence healthcare to remain living at home.
A person with dementia may qualify for covered home healthcare services. This will depend on their Medicare plan.
Prescription Savings Are Just the Beginning
See what other benefits you qualify for—from cashback cards to cheaper insurance.
To manage expectations, it’s important to understand home healthcare covered by Medicare. This will help avoid unexpected expenses from dementia, including Alzheimer’s disease.
Is home healthcare covered by Medicare for people with dementia?
Yes. Medicare covers home healthcare for dementia, but only if you meet certain criteria:
Your doctor must certify that you are homebound, which we will explain more in the next section.
You must be under the care of a doctor and receiving services as part of a care plan that is reviewed regularly.
Your doctor must certify that you need one or more of the following: intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational therapy, or a home health aide.
The home health agency caring for you must be certified by Medicare.
Homebound requirement
To qualify as homebound, you must meet the following criteria:
You have difficulty leaving home without a cane, a wheelchair, a walker, or help from another person. This could be the result of an illness — such as dementia — or an injury.
Leaving home is not recommended because of your condition.
You are unable to leave home, and it’s a major effort if you do.
Early onset Alzheimer’s
Early onset Alzheimer's occurs before age 65. It can be challenging for people and their families. Medicare covers people ages 65 and older. But younger individuals with early onset Alzheimer’s can qualify for coverage. This includes certain home healthcare services.
You are eligible if you have been receiving Social Security Disability Insurance, known as SSDI, for 24 months. If you are at least 55, you may qualify for home healthcare through the Program for All-Inclusive Care of the Elderly, which we will discuss later.
Need more Medicare-covered home healthcare? If you have dementia, you may be eligible for a chronic condition Medicare Special Needs Plan, which is a type of Medicare Advantage plan.
Expand your home healthcare services: Medicare enrollees who qualify, including those with dementia, can get more home healthcare and other services by joining a PACE program.
More than Alzheimer’s: Though Alzheimer’s is the most common, there are other types of dementia, including vascular dementia and Lewy body dementia.
Dementia home health services covered by Medicare
Medicare’s covered home healthcare benefits can include:
Skilled nursing care: This is part-time or intermittent care from a registered nurse or a licensed practical nurse. Services can include injections, tube feeding, wound care, and monitoring of serious illness.
Therapy services: This includes physical, occupational, and speech-language therapy to help improve or maintain your condition.
Medical social services: This includes counseling and assistance for social and emotional concerns related to dementia.
Medical supplies: Wound dressings and catheters necessary for home care are covered. So is durable medical equipment, including walkers, wheelchairs, and hospital beds. With original Medicare, you are responsible for paying your Part B deductible and 20% of the costs. The other 80% is covered.
Medications: This includes osteoporosis injections for women.
A chronic condition Medicare Special Needs Plan (a type of Medicare Advantage plan) can provide more benefits for people with dementia.
Read more like this
Explore these related articles, suggested for readers like you.
Cost
Original Medicare pays for 100% of covered home healthcare services.
Services not covered
Home healthcare services not covered by Medicare include:
Homemaking tasks, such as cleaning, laundry, and shopping
Personal care services, such as bathing and dressing, unless provided by skilled-nursing care; known as activities of daily living
Long-term care or custodial care
Meal delivery services
24-hour care at home
Some of these services may be covered for people dually enrolled in Medicare and Medicaid. The Program of All-Inclusive Care for the Elderly may also cover them.
Program of All-Inclusive Care for the Elderly
The Program for All-Inclusive Care of the Elderly, known as PACE, provides medical and social services to adults age 55 and older living at home. PACE offers a streamlined and comprehensive approach to senior care. This includes day center services and help at home. The program is available in most states and the District of Columbia.
Most PACE participants are eligible for both Medicare and Medicaid. About half have dementia. The program allows them to remain in their home and delay the move to a nursing home or memory care facility.
PACE services for dementia care include:
Adult day care
Family and caregiver support services, including respite care
Home care services, including support with activities of daily living
Home healthcare services
Rehabilitation services
Frequently asked questions
Medigap supplement plans typically don’t offer additional benefits. They cover out-of-pocket costs for Medicare-covered services, such as deductibles and coinsurance.
Use Medicare’s PACE plan finder to find out if there’s a program near you. The site will lead you to specific information, such as a program’s website, phone number, and hours. This tool tells you if a program is for people with Medicare only or for those who have Medicare and Medicaid.
The U.S. Department of Veterans Affairs (VA) offers dementia care services. VA healthcare services for dementia care include homemaker and home health aide services.
The bottom line
Medicare covers limited home healthcare for eligible enrollees with dementia. You will qualify for this benefit if you have been certified as homebound. Home healthcare services for Medicare enrollees with dementia include skilled nursing care, therapy services, and medical supplies.
Enrolling in a chronic condition Medicare Special Needs Plan (a type of Medicare Advantage plan) or the Program of All-Inclusive Care for the Elderly are ways to access expanded home healthcare benefits for dementia.
Why trust our experts?
References
Alzheimer’s Association. (n.d.). If you have younger-onset Alzheimer’s disease.
Centers for Medicare & Medicaid Services. (2023). Medicare & home health care.
Edemekong, P. F., et al. (2023). Activities of daily living. StatPearls.
Healthcare.gov. (2017). Medicare and Medicaid benefits for people with dementia.
Lankford, K. (2024). Does Medicare cover home health care? AARP.
Medicaid.gov. (n.d.). Programs of All-Inclusive Care for the Elderly benefits.
Medicare.gov. (n.d.). Home health services.
Medicare.gov. (n.d.). PACE.
Medicare Interactive. (n.d.). The homebound requirement.
Medicare Interactive. (2023). Does Medicare cover home health care?
Mendez, M. F. (2019). Early-onset Alzheimer disease and its variants. Continuum.
National PACE Association. (n.d.). PACE services.
National PACE Association. (n.d.). What Is PACE care?
Social Security Administration. (n.d.). Disability evaluation under Social Security.
U.S. Department of Veterans Affairs. (2023). Homemaker and home health aide care.
U.S. Department of Veterans Affairs. (2024). Dementia care (including Alzheimer’s disease).
Williams, C. T., et al. (2023). Program All Inclusive Care of the Elderly (PACE). StatPearls.
