Alzheimer's care and Medicare coverage
Alzheimer’s disease typically affects people ages 65 and older, making Medicare a key source of coverage. Benefits and out-of-pocket costs depend on the Medicare part or plan providing coverage.
Alzheimer’s disease is a degenerative disorder that leads to memory impairment and reduced cognitive abilities. It is responsible for 60% to 80% of all dementia cases in the United States, with the majority of those affected being people ages 65 years or older.
In general, Medicare provides various coverage for dementia care, including Alzheimer’s disease. This article gives a general overview of a person’s out-of-pocket costs for covered Alzheimer’s care under the different parts of Medicare. It also discusses what Medicare might not cover and what a person would be responsible for paying out of pocket.
When inpatient medical treatment or full-time care is necessary, Medicare Part A may cover a stay of up to 60 days in the hospital or up to 100 days in a skilled nursing facility (SNF), respectively.
A person usually does not pay a premium for Part A, but they must first meet an annual $1,676 deductible. After a person meets this amount, Medicare pays the full cost of their care for the allotted time periods. If their stay extends beyond these time periods, a person begins to incur additional daily charges.
Meanwhile, Part B should cover medical care, such as doctor exams, diagnostic tests, and needed medical equipment.
In the early stages of Alzheimer’s disease, either Medicare Part A or Part B may also pay for up to 8 hours per day and a maximum of 28 to 35 hours per week of home healthcare when this service is provided by a Medicare-certified home health agency.
After meeting the 2025 annual $257, Part B covers 80% of approved treatments and services. That said, a person must also pay a monthly premium starting at $185, depending on a person’s income.
It is important to remember that Original Medicare deductibles and premiums adjust annually and will be different in 2026.
Medicare Advantage (Part C) offers an alternative to Original Medicare, providing the same coverage along with additional benefits, such as vision or dental care.
One type of Part C plan, a Chronic Condition Special Needs Plan (CSNP), provides benefits specifically designed for individuals with chronic conditions such as dementia.
Managed by private insurers, Part C plans differ in terms of premiums, deductibles, and coinsurance. The average Part C monthly premium is expected to be around $17 in 2025. However, to remain enrolled, a person must still pay the Part B premium, although some Part C plans may reimburse part or all of that cost.
Some Part C plans include drug coverage, which are known as Medicare Advantage Prescription Drug (MAPD) plans. A person who enrolls in a plan without drug coverage or chooses to stay with Original Medicare will typically need to enroll in a separate Medicare Part D plan for prescription drug coverage.
Medicare Part D can cover necessary prescription medications for dementia, such as acetylcholinesterase (AChE) inhibitors. However, these plans are also managed by private insurers and categorize medications into tiers based on a formulary — a list of covered drugs. Every plan will have a different formulary, so coverage of any specific medication depends on the plan.
That said, plans must cover at least two drugs in commonly prescribed categories and most medications within six protected classes. Higher-tier drugs tend to be more expensive, while generic drugs typically fall into lower tiers and cost less.
In 2025, the maximum out-of-pocket cost for Part D is $2,000 ($2,100 in 2026), after which the plan covers all remaining drug expenses for the year. The national base monthly premium for Part D is $36.78 in 2025 ($38.99 in 2026), with a maximum annual deductible of $590 ($615 in 2026).
How much it might cost to care for a person living with Alzheimer’s disease depends on the care they need and where they’re receiving it.
According to the Alzheimer’s Association, as of 2024, the median costs without insurance for long-term care services, including home-based and community-based adult-day services, assisted living, and nursing home care, are as follows:
The amount a person’s Medicare part or plan will cover depends on the type of care they need, whether it is covered, and which part or plan they are enrolled in.
For people enrolled in Original Medicare, Medigap is an optional private plan that can help cover remaining out-of-pocket costs after coverage kicks in. This applies to costs such as deductibles and coinsurance.
That said, it is important to remember that Medicare will not cover general residence in a nursing home or assisted living unless it is a stay for a medical reason in an SNF. However, a person may have additional coverage options to help cover costs not covered by Medicare or any costs remaining after their coverage applies.
For example, a person who is also eligible for Medicaid or for Medicare’s Program of All-Inclusive Care for the Elderly (PACE) may be able to get additional coverage for some or all needed long-term care, while a person who is a veteran may be able to get additional coverage through the Department of Veterans Affairs (VA).
People living with dementia who
Alzheimer’s disease primarily affects individuals ages 65 years and older, who are eligible for Medicare.
Original Medicare can cover Alzheimer’s care under parts A and B. This includes home health in the early stages and skilled nursing in the later stages. That said, Original Medicare does not pay for long-term assisted living or accommodations unless medical documentation indicates a medical necessity.
Medicare Advantage (Part C) offers the same benefits as Original Medicare, along with additional coverage through specialized plans for people living with chronic conditions. Part D covers certain prescription drugs, but the coverage and costs vary per plan.
In general, costs such as deductibles, premiums, coinsurance, and copayments depend on the part of Medicare that provides coverage or the specific plan. Medigap may help to absorb some remaining costs incurred under Original Medicare after coverage applies.
A person may also receive additional coverage from Medicaid, PACE, the VA, or Social Security, if applicable. Other options that can help with coverage include private insurance, long-term care insurance, managed long-term care, or annuities or trusts.