Medicare is a health insurance program provided by the federal government. It’s for people aged 65 and older, as well as for some younger people with disabilities. People under 65 may be eligible, too, but only if they’ve received Social Security Disability benefits for at least two years.

Depending on your situation, an Alzheimer’s diagnosis can qualify you for Medicare before age 65. Here’s what Medicare pays and doesn’t pay for Alzheimer’s care.

Is Alzheimer’s a Qualifying Disability?

Early-onset Alzheimer’s disease can affect people in their 40s and 50s. But normally, to get on Medicare before age 65, you need to qualify for and receive disability benefits first.

The Social Security Administration recognizes Alzheimer’s disease as a disability. Early-onset Alzheimer’s is listed as a Compassionate Allowance. This means your application will be processed faster and approved more easily.

You can apply for disability benefits online, over the phone, or in person. The type of information you’ll need to provide includes:

• Birth certificate or citizenship documents
• Social Security number
• Documents for any marriages, divorces, or children
• Medical records
• Work history

For a full list of what you need to apply for disability benefits, view this checklist from the Alzheimer’s Association. Since Alzheimer’s is a progressive disease, healthcare needs and expenses tend to go up as the years go on. Applying for disability as soon as you can’t work will lay the groundwork for other benefits you’ll need in the future.

What Are the Different Parts of Medicare?

Once you qualify for Medicare (either because of your age or your Alzheimer’s diagnosis), it’s important to learn about the different aspects of the program. Medicare is broken down into a few parts. There’s some overlap in what each part covers. Most people get a combination of two or three parts of Medicare for their overall healthcare expenses.

Medicare Part A is hospital insurance. It can help with the cost of care provided by:

• A skilled nursing facility (nursing home care)
• Inpatient hospital stays
• Home healthcare
• Hospice care

Home healthcare can also be covered by Medicare Part B. Part B is medical insurance. It also covers:

• Medical equipment, like wheelchairs, oxygen tanks, and hospital beds
• Care that’s provided in an outpatient setting
• Preventive care, like vaccines and wellness visits

Medicare Part D is the drug plan. It’s used to help pay for prescription drugs, which can also include vaccines.

Medicare Part C is a combination plan. It includes Parts A, B, and sometimes D. Another name for Medicare Part C is Medicare Advantage. Medicare Advantage is an alternative to the “Original Medicare” plan, which includes Parts A and B.

Original Medicare and Medicare Advantage plans are both similar and different. The cost of these two “bundled” options may vary. In addition, people with a Medicare Advantage Plan are limited to certain doctors in their network. But with Original Medicare, it’s OK to see any doctor who accepts Medicare around the country.

Using Medicare for Alzheimer’s Disease

Original Medicare is Parts A and B. It covers a range of Alzheimer’s costs, from the first diagnostic tests and evaluations to ongoing treatment and care planning for the future. Medicare Part D may help cover medications and treatment costs for Alzheimer’s disease.

Medicare Parts A and B

Original Medicare may cover behavioral specialists, counseling services, and psychiatric care. However, it only pays 80 percent of the cost for approved mental health services. Medigap is a private insurance policy that you can add to Medicare to pay for out-of-pocket expenses, like copays and deductibles.

Medicare Part A covers the care you receive inside a hospital or nursing home, including any medications you’re given during those stays. It also covers hospice services or care provided to you at home.

If you go to an outpatient facility, your care will be covered under Medicare Part B. For Alzheimer’s, outpatient services may include:

• Imaging tests like MRI or CT scans
• Physical therapy or occupational therapy sessions
• Speech therapy
• Yearly physicals

Original Medicare may cover some of the costs of a long-term care or assisted living facility, but you have to qualify for it.

Medicare Part B also covers monoclonal antibodies — lab-made proteins that help the body target harmful substances — that are FDA-approved for Alzheimer’s disease.

Original Medicare helps with care planning for Alzheimer’s disease. The types of services covered include:

• Arranging advanced care directives
• Conducting cognitive assessments
• Planning for palliative care
• Referring to community services and resources
• Reviewing medications
• Screening for safety issues, such as driving ability
• Providing support for caregivers

In 2025, the Centers for Medicare and Medicaid Services (CMS) is launching a new model called Guiding an Improved Dementia Experience (GUIDE) for people with dementia and their caregivers. It aims to help caregivers navigate caring for a loved one with dementia, provide resources, and cover additional healthcare costs. Ask your healthcare provider if you might be eligible for this program.

Medicare Part D

All Medicare Part D plans must cover at least two types of medications for Alzheimer’s disease. This usually includes cholinesterase inhibitors and memantine. These drugs must have full FDA approval to be covered. In some cases, newer Alzheimer’s treatments — such as certain monoclonal antibodies — may also require your doctor to enroll you in a treatment registry. Antidepressants, antipsychotics, and anticonvulsants are also commonly covered.

What’s Not Covered by Medicare?

Alzheimer’s care is a big expense. And unfortunately, many of the costs aren’t covered by Medicare. For instance, Medicare usually doesn’t cover respite care to take a break from caregiving, unless you qualify for the GUIDE program. The same is true if you hire help from a personal aide.

Medicare doesn’t usually cover:

• Adult day care (part of these costs might be covered if you qualify for the GUIDE program)
• Incontinence products
• Over-the-counter vitamins and supplements

Custodial care provided in a nursing home may also not be covered. If someone stays at a nursing home for an extended time (more than 100 days), Medicare doesn’t cover the cost past 100 days.

People with Alzheimer’s disease can consider getting a Medicare Special Needs Plan if they want more support with the cost of Alzheimer’s care. This version of Medicare Advantage is meant for people with dementia.

Researching More Programs To Fill the Gap

If you’re overwhelmed trying to understand Medicare and other insurance plans, you’re not alone. Members of myALZteam have noted that navigating insurance and government programs can be tricky.

“My partner was approved for Medicaid, but I just got a packet for Medicare Part A and B,” shared one member. “He’s 55, so he gets it because of his disability due to Alzheimer’s. I have no idea if we need both Medicaid and Medicare A and B. It said I would have to pay to keep Medicare Part B, but it didn’t say how much. I’m so confused.”

A licensed health insurance agent can help you sort out what type of insurance makes sense for your situation. Although Medicare can help, it’s not enough to cover every expense of Alzheimer’s disease. That’s why it’s important to familiarize yourself with other resources, such as Medicaid, long-term care insurance, and programs in your state. Meet with a social worker through your healthcare provider or community resource (like a senior center) to learn what care planning services are available.

“I would try your local government aging office,” suggested a myALZteam member. “Ours has a caregiver unit. They can’t direct you but will talk to you about options. It’s been helpful to me. Also, your state or local Alzheimer’s Association is a fountain of information.”

If Medicare Isn’t Enough

Although Medicare can offer valuable support for people living with Alzheimer’s, it doesn’t cover all care needs. Understanding what’s included — and where the gaps are — can help you plan ahead. Exploring additional resources like Medicaid, special programs, and community services can also help both you and your loved one.

Talk With Others Who Understand

On myALZteam, the social network for people with Alzheimer’s disease and their caregivers, members come together to ask questions, give advice, and share stories with others who understand life with Alzheimer’s disease.

Do you have any experience getting Medicare coverage for Alzheimer’s disease? What Medicare plans did you select for yourself or your family member? Share in the comments below, or start a conversation by posting on your Activities page.