June is Alzheimer's & Brain Awareness Month. You're here. We’re guessing you're already aware. What you may have questions about is how to pay for memory care, and what the government does and doesn’t cover when it's time to foot the bill.

🎙️ The Sandwich Generation Pod shared their two-part series on Medical Assistance for Long Term Care with elder-law attorney Rachel Schromen.

🏠 Architectural Digest profiled six older adults and the different living arrangements they've chosen.

🏃 At 90, Bill Schwarz ran his first-ever marathon, all 26.2 miles of it, in a little over nine hours. He'd never run one before.

👩‍👧‍👦 A mom living in Spain is a 24/7 remote caregiver for her 80-year-old mother, who’s living in another country.

📉 About 70% of seniors will need long-term care, and almost no one can afford it.

When it comes to picking up the tab for memory care, the federal government can feel like your aunt’s new husband who somehow made the birthday dinner invite list but can't find his wallet when the bill arrives.

If you thought Uncle Sam would be chipping in for Mom’s digs, you’re in good company. A 2024 poll from the University of Michigan found that 62% of adults over 50 mistakenly believe Medicare covers long-term care like assisted living or memory care, which it does not.  

Memory care runs about $8,000 per month. And that's the national average. In major metro areas like San Francisco, Los Angeles, and New York, rates regularly exceed $10,000 a month. Memory care tends to cost about 20% more than standard assisted living, because it requires locked, secure environments, staff trained specifically in dementia care, and structured programming designed to reduce agitation, and support cognitive function. 

Medicare (the original kind)

Original Medicare (Parts A and B) does help a bit and will cover cognitive impairment assessments and diagnosis, care planning services, annual wellness visits, inpatient hospitalization to treat an injury or illness, and up to 100 days of skilled nursing care following a qualified hospital stay which is where it gets even more confusing. The care must be medically necessary and not custodial in nature. Custodial is considered personal care helping with daily activities like eating, dressing, and using the bathroom. Most people in memory care fall into the latter category and therefore will not qualify. While varying by plan and provider, Medicare Advantage plans tend to provide similar coverage and have similar limitations.

Medicare Part D (the drug part) covers prescription medications for Alzheimer's, with a $2,000 out-of-pocket cap on drug costs in 2026.

There's an asterisk to original Medicare's hands-off approach to long-term dementia care. The GUIDE Model (Guiding an Improved Dementia Experience) is a free Medicare program launched in July 2024 as an eight-year pilot that covers the costs of dementia care navigation services for eligible individuals. That includes a care navigator who helps coordinate services, and up to $2,500 worth of respite care per year. Not available everywhere but worth asking mom’s doc about if you’re managing a dementia diagnosis.  

Medicaid 

Medicaid is the safety net that Medicare isn't, but it's also more complicated than most people realize, because there are effectively two different versions of it. 

Medicaid is jointly funded by the federal government and state governments. Regular Medicaid is the government-funded healthcare coverage for people with limited income and assets. Long-term care Medicaid (the umbrella term for a patchwork of state-run programs) is a separate group of programs that covers care for people who can no longer live independently, whether due to aging or a chronic condition like dementia. They have different eligibility rules, different income and asset limits, and different benefits. Most people who know they 'have Medicaid' are on the regular version and are surprised to find out it doesn't cover a memory care facility.

Long-term care Medicaid covers three main settings: nursing home care, home and community-based services through state waiver programs, and in many states, assisted living. Unlike regular Medicaid, it has its own separate income limits, asset rules, look-back periods, and estate recovery requirements.

Qualifying for long-term care Medicaid requires meeting three tests simultaneously: a functional test, an income test, and an asset test. For the functional test, Mom  must demonstrate a medical need for nursing-level care and typically be assessed by a physician, with most states requiring help with at least two to three activities of daily living (ADLs).

On the financial side, the limits are strict. For individuals in most states in 2026, the asset limit is $2,000 (CA, NY, and IL have higher limits). For married couples where only one spouse is applying, the applicant is limited to $2,000 while the at-home spouse can keep up to $162,660, a federal protection designed to prevent the healthy spouse from being left with nothing. The income limit in most states is $2,982 a month.

If Mom has more than that — savings, investments, or a second property — she'll need to spend down to those thresholds before Medicaid kicks in. That process can take months or years depending on what she's saved over a lifetime.

Then there's the look-back period. In 49 states, Medicaid reviews all financial transactions from the five years before Mom applies. If assets were transferred or gifted for less than fair market value during that window, Medicaid can impose a penalty period of ineligibility. The intent is to prevent people from giving away assets to qualify faster. The effect is that families who didn't plan years in advance often find themselves stuck.

Once Mom qualifies, long-term care Medicaid pays 100% of nursing home costs, including memory care services. For families who want to keep her at home, Medicaid may help through Home and Community-Based Services waivers but enrollment is usually capped and waitlists can be long.

Most families pay out of pocket for as long as they can, lean on long-term care insurance if Mom bought a policy, explore veterans benefits if applicable, and eventually turn to Medicaid. The earlier you bring in an elder law attorney or financial planner, the more options you and Mom have.

How to find help:

Eldercare Locator - A free government service that connects families to local aging resources, including Medicaid navigators and Area Agencies on Aging.

National Academy of Elder Law Attorneys - Find an attorney who specializes in Medicaid planning, asset protection, and long-term care.

U.S. Department of Veterans Affairs - If Mom or Dad served, VA benefits may help cover long-term and memory care costs.

Caring Across Generations - A national advocacy organization working to make care more accessible and affordable for families.

You can’t fail this one. Answers and another quiz drop next week.

You said it. This week’s submissions.

"Deep Brain Stimulation worked! We were able to reduce her Parkinson's meds and it's helping Mom feel better."

"Took my mom to see family and they got a good look at what I'm dealing with on a daily basis."

"I made my brother help me with Mom...he's a little irritated but helping...a win!"

"My dad was recently diagnosed with Parkinson's and my mom is getting a hip replacement. It's alot." 

"After 2 years of poor ambulation, Dad was able to walk some without a walker."