Alzheimer's and Dementia Under Medicare: Memory Checks, Diagnosis, and Drugs Like Leqembi

Here's the short answer. Medicare Part B covers a cognitive assessment (a memory and thinking check) at your yearly Wellness visit. It also covers a separate longer visit to confirm a diagnosis like Alzheimer's disease and make a care plan. Part B may also cover FDA-approved Alzheimer's drugs such as Leqembi (lecanemab) and Kisunla (donanemab), but only if your provider collects evidence for a qualifying study or registry. For both, after the Part B deductible you pay 20% of the Medicare-approved amount.

Step 1: A memory check at your Wellness visit

Your provider can look for signs of dementia during your yearly "Wellness" visit and at other visits. Signs of trouble include trouble remembering, learning new things, concentrating, managing money, and making decisions. Depression, anxiety and delirium can also cause confusion, so it matters to find the cause. To learn more about this visit, see Wellness Visit vs. Physical.

Step 2: The separate cognitive assessment and care plan visit

Part B covers a separate visit to fully review your thinking and memory, establish or confirm a diagnosis, and build a care plan. At this visit, your provider may:

• Do an exam, ask about your history, and review your medicines.
• Identify your supports, including care your usual caregiver can give.
• Make a care plan for your symptoms.
• Help you set up or update an advance care plan.
• Refer you to a specialist and point you to community help, such as adult day health programs and support groups.

All of the above come from Medicare.gov. You can bring a spouse, friend or caregiver. The Part B deductible and 20% coinsurance apply.

Step 3: Alzheimer's drugs like Leqembi and Kisunla

These drugs are called monoclonal antibodies. They target beta-amyloid plaques in the brain. They may slow or delay symptoms, but they don't cure or reverse the disease.

Who is eligible

Your provider must confirm that you have beta-amyloid plaques consistent with Alzheimer's disease. They must also diagnose you with mild cognitive impairment due to Alzheimer's, or mild dementia due to Alzheimer's.

The registry rule

Medicare coverage requires your provider to collect evidence on how well the drug works for a qualifying study or registry. Ask your provider's office whether they take part before you plan treatment.

What you pay

After the Part B deductible, you pay 20% of the Medicare-approved amount. You may also need scans and tests before or during treatment, which can add to your costs. The drug is given by IV in a provider's office or other outpatient setting. Medigap or other coverage may pay some of the 20%. See Medigap Plans.

If you don't meet the Part B rules

Your Medicare drug plan (Part D) might cover it. Contact your plan.

Extra support for families

Some people living with dementia, and their unpaid caregivers, may get added support through the Guiding an Improved Dementia Experience (GUIDE) Model without paying coinsurance. Ask your provider whether they take part. For caregivers, see Caregivers.

What Medicare doesn't solve

Long-term care for dementia is a different question. See Medicare and Long-Term Care. Cancer care has its own page too: Medicare and Cancer Treatment.

Common questions

Official sources

• Medicare.gov: Cognitive assessment & care plan services
• Medicare.gov: Monoclonal antibodies for early Alzheimer's
• Medicare.gov: Medicare & You handbook