Medicare GUIDE Program: Dementia Care, Respite Care & Eligibility FAQ
If you or a loved one is living with dementia, the Medicare GUIDE Program may provide valuable support to help make living at home easier for both the individual and their caregiver. GUIDE—Guiding an Improved Dementia Experience—is a Medicare program that offers dementia care coordination, caregiver education and support, and, for eligible participants, respite care services. Kore Cares works with EmpowerMe Medical Group as a GUIDE respite partner and can help families understand the program, determine their next steps and access in-home respite care when eligible. Below, we answer common questions about Medicare GUIDE eligibility, respite care benefits and how to get started.
What is the Medicare GUIDE Program?
GUIDE stands for Guiding an Improved Dementia Experience. It is a Medicare program that provides support, education and care coordination to help people living with dementia remain safely at home. Through GUIDE, individuals living with dementia and their caregivers may receive care navigation, caregiver support, medical support and respite care services.
Who may qualify for GUIDE?
GUIDE may be available to individuals who have been diagnosed with dementia, have traditional Medicare Parts A and B, live at home and have not elected the Medicare hospice benefit. Participants cannot be enrolled in Medicare Advantage, Special Needs Plans or PACE or reside in assisted living, memory care or a long-term nursing home.
What services are available through GUIDE?
GUIDE can provide caregiver education and support, help connecting to resources and referrals, care coordination, respite care, telehealth access when additional support is needed and connections to specialty providers when appropriate.
Does Medicare GUIDE provide respite care?
Yes. Eligible individuals may receive up to $2,625 per year for eligible respite services, which may include in-home respite care or adult day services. Additional eligibility requirements apply to the respite benefit.
What is respite care?
Respite care is short-term support that gives caregivers time to rest and recharge while their loved one continues to receive safe, attentive care. It can give a caregiver time for their own appointments, errands, family activities, rest or other needs.
How can Kore Cares help?
Kore Cares works with EmpowerMe Medical Group as a GUIDE respite partner. For eligible GUIDE participants referred to us for in-home respite care, our trained care professionals can provide support in the home while the family or unpaid caregiver takes a needed break.
Do I need to already be enrolled in GUIDE before contacting Kore Cares?
No. You can start by calling Kore Cares. Our team can help you understand the program and take the next steps to determine whether GUIDE may be an option for you or your loved one. Final GUIDE eligibility and enrollment are determined through the GUIDE assessment process.
Does GUIDE replace my regular doctor?
No. Individual's primary care physician remains at the center of their care, with GUIDE providing additional support and coordination.
Does someone need to have advanced dementia to participate in GUIDE?
Not necessarily. GUIDE is for people living with dementia who meet the program's eligibility requirements. However, the respite benefit has additional requirements. The participant must have a FAST score of 5 or higher and an unpaid relative or non-relative caregiver who assists with activities of daily living or instrumental activities of daily living. Kore Cares team can guide you through the assessment and approval process.
What if I'm not sure whether my loved one qualifies?
That's okay. You don't have to determine eligibility yourself. Call Kore Cares and we'll help you start the process. We can help connect you with the appropriate GUIDE resources so eligibility can be evaluated.
How do I get started?
Call Kore Cares and tell us you're interested in the Medicare GUIDE Program. We'll help you understand the next steps and how GUIDE respite care may be able to support your family.
Could GUIDE Help Your Family?
If you or someone you care for is living with dementia and has traditional Medicare, call Kore Cares today. We'll help you start the process and explore whether GUIDE may be an option.
To Learn more:
Call Kore Cares
Watch this video by CMS
Check out this CMS Dementia Care Pathways Infographic