Medicare covers some nursing home care for dementia, but not all of it, and the coverage depends on what type of care you need and how long you stay

Medicare Part A covers up to 100 days in a skilled nursing facility (SNF) each benefit period, but only if you meet specific conditions: you must have been in a hospital for at least three consecutive days first, and a doctor must order the care as medically necessary. For dementia alone, this is rarely the case. Medicare covers skilled nursing care — wound care, medication management, physical therapy — not custodial care, which is help with daily activities like bathing, dressing, and eating. Most people with dementia in nursing homes need custodial care, which Medicare does not pay for.

If you have dementia and also need skilled care — for example, you broke your hip and need rehabilitation, or you have a wound infection — Medicare may cover the nursing home stay while you recover that specific condition. Once you no longer need skilled care, Medicare stops paying, even if you remain in the facility. At that point, you or your family must pay out of pocket, use Medicaid (if you may have access to), or rely on long-term care insurance if you have it.

Key Takeaways

  • Medicare Part A covers skilled nursing care in a facility for up to 100 days per benefit period, but only after a three-day hospital stay and only for the skilled care itself, not for dementia care alone.
  • Custodial care — help with bathing, dressing, eating, and toileting — is not covered by Medicare, and this is the main type of care most people with dementia need.
  • Medicare stops paying once you no longer need skilled care, even if you stay in the same nursing home.
  • Medicaid, not Medicare, is the program that typically pays for long-term custodial nursing home care for people with dementia who have limited income and assets.
  • Long-term care insurance, if purchased before diagnosis, may cover nursing home costs that Medicare does not.

When Medicare Part A Covers Nursing Home Care

Medicare Part A pays for a nursing home stay only when two conditions are met at the same time. First, you must have spent at least three consecutive days in a hospital (not counting the day you were discharged). Second, a doctor must order the nursing home care as medically necessary within 30 days of leaving the hospital, and the care must be for a condition that was treated in the hospital.

The nursing home must also be a Medicare-certified skilled nursing facility. Not all nursing homes are certified — some are residential care facilities or assisted living communities, which Medicare does not cover at all. When you are discharged from the hospital, the discharge planner should tell you whether the facility you are going to is Medicare-certified and whether your stay will be covered.

Even when these conditions are met, Medicare only pays for skilled care. Skilled care means services that require the training and judgment of a nurse or therapist — intravenous medications, wound dressing changes, physical therapy after surgery, or monitoring of a complex medical condition. If you are in the nursing home only because you have dementia and need help with daily activities, Medicare does not cover it, even if you also have other health conditions.

What Medicare Does Not Cover in a Nursing Home

Medicare does not pay for custodial care, which is the day-to-day help most people with dementia need. Custodial care includes bathing, dressing, grooming, toileting, eating, and moving around. It also includes supervision and reminders to take medication or keep appointments. Even if a person with dementia lives in a nursing home and a nurse is present, if the nursing home is providing only custodial care, Medicare will not pay.

Medicare also does not cover the room, board, or meals in a nursing home — only the skilled nursing services. If you are receiving skilled care, you pay a copay for days 21 through 100 of your stay (as of 2024, this is $200 per day, though this amount changes yearly). You pay the full cost of the room and meals yourself.

Dementia care itself — memory care programs, behavioral support, activities designed for people with cognitive loss — is not a skilled service under Medicare rules. Some nursing homes have special dementia units, but Medicare does not pay extra for these, and if the care provided is only custodial, Medicare does not pay at all.

How Long Medicare Pays and What Happens After

Medicare Part A covers up to 100 days in a skilled nursing facility per benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave the nursing home. If you return to the hospital and then to a nursing home within that 60-day window, the days do not reset — you continue counting from where you left off.

After 100 days, Medicare stops paying. If you still need skilled care, you must pay out of pocket or use another source of payment. If you need only custodial care at that point — which is common for people with dementia — you must find another way to pay: Medicaid, long-term care insurance, family resources, or a combination of these.

Many people with dementia do not reach 100 days of skilled care because they improve enough to go home, or because their condition changes and they no longer need skilled services. Once Medicare determines that skilled care is no longer medically necessary, it stops paying when ready, even if you stay in the nursing home.

Medicaid Coverage for Dementia Nursing Home Care

Medicaid, not Medicare, is the program that pays for long-term custodial nursing home care for most people with dementia. Medicaid is a joint federal and state program for people with low income and limited assets. Each state sets its own rules for what it covers and who qualifies, so coverage varies by where you live.

To may have access to for Medicaid nursing home coverage, you must meet income and asset limits. These limits are lower than many people expect — in most states, your monthly income must be under $2,500 (though this varies), and your countable assets must be under $2,000. A home you live in, one car, and some personal items do not count toward the asset limit, but savings, investments, and a second property do.

If you have too many assets to may have access to for Medicaid now, you may be able to spend down your assets on care or other allowed expenses, or you may be able to use a Medicaid planning strategy. This is complex and varies by state, so talking with an elder law attorney or a Medicaid planner before you need nursing home care can help you understand your options.

Long-Term Care Insurance and Other Payment Sources

Long-term care insurance, if you purchased it before being diagnosed with dementia, may cover nursing home costs that Medicare does not. These policies vary widely — some cover only skilled nursing care, some cover custodial care, and some cover both. If you have a long-term care insurance policy, review it or contact the insurance company to understand what your policy covers and what you must pay out of pocket.

Veterans and their surviving spouses may be able to use VA benefits to help pay for nursing home care. The VA Aid and Attendance benefit can help cover the cost of care for veterans with dementia who meet service and income requirements. This is separate from Medicare and Medicaid and is worth exploring if you or a family member is a veteran.

Many families pay for nursing home care out of pocket, at least for the first months or years. Nursing home costs vary widely by location — from under $5,000 per month in some rural areas to over $10,000 per month in urban areas — so the financial impact depends on where you live and how long care is needed. Some families use a combination of Medicare (for skilled care periods), personal savings, long-term care insurance, and eventually Medicaid (once assets are spent down).

Questions to Ask Your Doctor and the Nursing Home

Before or during a nursing home stay, ask your doctor whether the care being provided is skilled care or custodial care, and how long skilled care is expected to be needed. Ask whether Medicare will cover the stay and for how long. Get this in writing if possible, because coverage decisions can change if your condition improves or worsens.

Ask the nursing home whether it is Medicare-certified and whether it accepts Medicaid. Ask what the daily cost is and what is included in that cost. Ask what happens to your payment responsibility when Medicare stops paying. Ask whether the facility has a social worker who can help you understand payment options and plan for what comes next.

If you have a long-term care insurance policy, contact the insurance company before admission to understand what it will cover and what paperwork you need to submit. If you think you may eventually need Medicaid, ask the nursing home social worker about the process and timeline for explore.

Frequently Asked Questions

If my parent has dementia and lives in a nursing home, will Medicare pay for it?

Only if your parent also needs skilled care — such as wound care, physical therapy, or IV medications — ordered by a doctor after a hospital stay of at least three days. If the nursing home is providing only help with daily activities (bathing, dressing, eating), Medicare does not pay. Medicaid may pay if your parent meets income and asset limits.

What if my parent was in the nursing home before going to the hospital?

Medicare will not cover the nursing home stay. Medicare only covers a nursing home stay that begins after a hospital stay of at least three consecutive days. If your parent was already in the nursing home and then went to the hospital, the nursing home stay before the hospital is not covered by Medicare.

Can Medicare cover dementia care in assisted living or memory care facilities?

No. Medicare only covers care in a skilled nursing facility, and only for skilled services. Assisted living and memory care facilities are not skilled nursing facilities, so Medicare does not pay for care in these settings, even if skilled services are provided there.

How much will I have to pay out of pocket for a nursing home stay Medicare covers?

You pay nothing for days 1 through 20. For days 21 through 100, you pay a daily copay (currently $200 per day as of 2024, though this changes yearly). You also pay the full cost of room and board. After 100 days, you pay the full cost of everything.

What should I do if I cannot afford nursing home care?

Talk to the nursing home social worker about Medicaid, Veterans benefits if applicable, and payment plans. Contact your local Area Agency on Aging for information about other resources. If you have assets, consider speaking with an elder law attorney about Medicaid planning before you need care.