Anthem Memory Care: What the Coverage Actually Includes

Anthem offers memory care coverage through its Medicare Advantage and Medigap plans, but what that coverage pays for depends entirely on which plan you hold and whether you are in a facility Anthem has contracted with. Anthem does not run memory care facilities itself — it reimburses care provided by nursing homes, assisted living communities, and specialized dementia units that have signed agreements with Anthem. The coverage is not automatic; you need to understand what your specific plan covers, what your out-of-pocket costs will be, and whether the facility you are considering accepts your Anthem plan.

Memory care is a specialized form of long-term care for people with Alzheimer's disease or other dementias. It includes 24-hour supervision, medication management, information with daily activities, and programming designed for cognitive decline. Anthem's coverage of memory care varies sharply between plan types. A Medicare Advantage plan may cover some skilled nursing facility care but typically does not cover assisted living or standalone memory care units. A Medigap plan covers what Original Medicare covers — which is limited to skilled nursing facility stays that follow a hospital admission. Neither covers custodial care, which is what most memory care actually is.

Key Takeaways

  • Anthem memory care coverage depends on your plan type: Medicare Advantage plans have different limits than Medigap plans, and neither covers most assisted living or standalone memory care facilities.
  • You must confirm the specific facility accepts your Anthem plan before moving, because Anthem's network of contracted providers is not the same as Medicare's network.
  • Skilled nursing facility stays covered by Anthem require a hospital stay first and are limited to 100 days per benefit period, with your costs rising after day 20.
  • Most memory care costs — especially in assisted living or specialized dementia units — are paid out of pocket, and Anthem coverage does not extend to custodial care, which is the bulk of what memory care provides.
  • Your Anthem member services team can tell you which facilities in your area are in-network, but you should also call the facility directly to confirm they accept your specific plan.

How Anthem Medicare Advantage Plans Cover Memory Care

If you have an Anthem Medicare Advantage plan, your memory care coverage is limited to skilled nursing facility (SNF) care, and only after a may have access to hospital stay. You must be admitted to the hospital for at least three consecutive days, then transferred directly to a skilled nursing facility. Anthem will cover part of your SNF stay — typically the first 20 days at no cost to you, then days 21 through 100 with a daily copay that varies by plan, usually between $150 and $250 per day. After 100 days in a benefit period, Anthem coverage ends.

This matters because most memory care facilities are not skilled nursing facilities. They are assisted living communities or specialized dementia units that provide custodial care — help with bathing, dressing, meals, and supervision — rather than skilled nursing. Anthem does not cover custodial care, which means you pay the full cost out of pocket. If you need memory care but have not had a recent hospital stay, Anthem will not pay anything.

Some Anthem Medicare Advantage plans include additional benefits like adult day care or respite care, but these vary by plan and by state. You must check your plan documents or call Anthem member services to know what your specific plan includes. Do not assume your plan covers memory care just because you have Medicare Advantage with Anthem.

Medigap Plans and Memory Care: What Is and Is Not Covered

Anthem Medigap plans follow Original Medicare's rules for memory care coverage. That means Anthem covers skilled nursing facility care only after a three-day hospital stay, and only for up to 100 days per benefit period. Your costs are the same as with Medicare Advantage: nothing for days 1 through 20, then a daily copay for days 21 through 100. After day 100, you pay everything yourself.

Medigap plans do not cover assisted living, memory care communities, or any custodial care setting. They also do not cover long-term care insurance or private-pay memory care. If you need memory care in a setting other than a hospital-connected skilled nursing facility, Medigap will not help you pay for it. This is a hard limit, not a gap you can fill with a supplemental plan.

The one advantage Medigap has over Medicare Advantage is stability: your coverage rules do not change year to year, and you can use any provider that accepts Medicare, not just Anthem's contracted network. But that does not change the fact that memory care in most settings is not covered.

Finding In-Network Memory Care Facilities

Anthem maintains a network of contracted skilled nursing facilities, and you should confirm that any facility you are considering is in that network before you move. You can search Anthem's provider directory on their website, or call Anthem member services and ask them to list all SNFs in your area that accept your specific plan. Write down the names and addresses, because the directory is not always current.

After you have a list from Anthem, call each facility directly and confirm three things: that they accept your Anthem plan, that they have memory care or dementia units available, and what their current wait time is. Do not rely on Anthem's directory alone — facilities sometimes leave the network or stop accepting certain plans without updating the directory when ready. The facility's admissions office will know whether they are currently accepting your plan.

If you are looking at assisted living or a standalone memory care community, call Anthem first to confirm they do not cover it. Many people assume Anthem covers any memory care facility, then discover mid-move that they do not. It is far easier to know this before you sign a lease or pay a deposit.

What You Will Pay Out of Pocket

Your out-of-pocket costs for memory care depend on the setting and your plan. In a skilled nursing facility covered by Anthem, you pay nothing for days 1 through 20, then a daily copay for days 21 through 100. That copay ranges from $150 to $250 per day depending on your plan, which means days 21 through 100 could cost you $12,000 to $20,000 total. After day 100, you pay the full cost of care, which averages $8,000 to $12,000 per month for skilled nursing.

In an assisted living or memory care community, you pay the full cost out of pocket. Memory care in assisted living typically costs $4,500 to $8,000 per month, depending on your location and the level of care needed. In a standalone memory care community, costs often run $6,000 to $10,000 per month or higher. Anthem does not contribute anything to these costs.

Some people use long-term care insurance, personal savings, or Medicaid to pay for memory care that Anthem does not cover. Medicaid covers custodial care in most states, but you must meet income and asset limits, and you must spend down your savings first. This is a separate process from Anthem coverage and requires a different process.

How to Read Your Anthem Plan Documents

Your Anthem plan documents spell out exactly what memory care is covered, but they use specific language that can be confusing. Look for sections titled "Skilled Nursing Facility", "Long-Term Care", or "Post-Acute Care". Read the requirements carefully: most plans will say something like "covered after a three-day may have access to hospital stay" or "limited to 100 days per benefit period". These are not suggestions — they are hard limits.

If your plan documents mention "custodial care" or "assisted living", they will say it is not covered. Do not skip over that sentence. If you cannot find the information in your documents, call Anthem member services and ask them to read the relevant section to you over the phone. Write down what they say and ask them to send you a written confirmation by email. This protects you if there is a dispute later about what is covered.

Your plan documents also list your copays and coinsurance amounts. These are the costs you will owe out of pocket. If your plan says you owe $200 per day for SNF care after day 20, that is what you will owe — Anthem will not waive it or negotiate it down.

What Happens When Anthem Coverage Runs Out

If you exhaust your 100 days of Anthem-covered skilled nursing facility care, you become responsible for the full cost. At that point, you have several options. You can continue paying out of pocket if you have savings. You can move to a less expensive facility. You can explore for Medicaid, which covers custodial care in most states but requires you to spend down your assets first. Or you can move back home and arrange for home care, which may be covered by Medicaid or paid privately.

Some people transition from skilled nursing to assisted living or memory care at this point, because assisted living is often cheaper than skilled nursing and may be covered by Medicaid. Others stay in skilled nursing and pay privately. There is no single right answer — it depends on your savings, your family's ability to help, and what care settings are available in your area.

If you think you will need long-term memory care, talk to your family and a financial planner now about how you will pay for it. Anthem's coverage is a bridge, not a solution. Knowing that now, while you still have time to plan, is far better than discovering it in a crisis.

Frequently Asked Questions

Does Anthem cover memory care in assisted living?

No. Anthem covers only skilled nursing facility care, and only after a hospital stay. Assisted living and standalone memory care communities provide custodial care, which Anthem does not cover under any plan type. You would pay the full cost out of pocket or through Medicaid if you may have access to.

What if I need memory care but have not been hospitalized?

Anthem will not cover memory care without a may have access to hospital stay. If you need care but have not been hospitalized, you must pay out of pocket, explore for Medicaid, or explore other funding sources like long-term care insurance or family support. Some people enter a hospital for evaluation or treatment first, which then qualifies them for SNF coverage.

Can I use any memory care facility, or does it have to be in Anthem's network?

If Anthem is covering your care, the facility must be in Anthem's network and contracted to accept your specific plan. If you are paying out of pocket, you can use any facility. Always confirm with both Anthem and the facility that they have a current contract before you move.

How long does Anthem cover memory care in a skilled nursing facility?

Anthem covers up to 100 days per benefit period in a skilled nursing facility. You pay nothing for days 1 through 20, then a daily copay (usually $150 to $250) for days 21 through 100. After 100 days, Anthem coverage ends and you pay the full cost.

What should I do if Anthem denies my memory care claim?

Ask Anthem in writing why the claim was denied and request the specific plan language they are using to deny it. Common reasons include: the facility is not in-network, you did not have a may have access to hospital stay, or you have exceeded 100 days. If you disagree with the denial, you can file an appeal. Anthem must respond to appeals within 30 days.