If you're caring for someone with dementia, you may not know that Medicare now offers a comprehensive support program designed specifically for you. The GUIDE model (Guiding an Improved Dementia Experience) launched in 2024 and provides coordinated dementia care, caregiver training, 24/7 support lines, and up to $2,500 annually for respite care to give you desperately needed breaks from caregiving.
Many family caregivers struggle alone, unaware that this program exists or unsure how to access it. GUIDE is a Medicare Innovation Center initiative that's testing whether comprehensive, coordinated dementia care can help people stay home longer while reducing caregiver burnout and preventing unnecessary hospitalizations. As of 2026, 327 organizations nationwide participate in the program, with ongoing expansion to rural and underserved communities.
This guide will help you understand what GUIDE offers, whether you and your loved one qualify, how to find participating providers, what the enrollment process involves, and how to actually access the caregiver supports and respite services that can make your caregiving more sustainable.
Key takeaway:
The Medicare GUIDE model provides eligible dementia patients and their family caregivers with coordinated care through interdisciplinary teams, free caregiver training and education, 24/7 crisis support, and up to $2,500 per year in respite care funding to reduce caregiver burden and help keep loved ones at home longer.
If you only do 3 things this week
- 1.Check whether your loved one's doctor, clinic, or healthcare system participates in GUIDE by visiting cms.gov/innovation/innovation-models/guide or calling 1-800-MEDICARE (1-800-633-4227) to find participating programs in your area.
- 2.Gather essential documents including your loved one's Medicare card and number, recent dementia diagnosis from their physician, current medication list, and your information as the primary caregiver to prepare for potential enrollment.
- 3.Use the Alzheimer's Association screening tool at alz.org/help-support to assess your eligibility and connect with local dementia care resources that may participate in or supplement GUIDE services.
What is the Medicare GUIDE model and what does it provide?
Short answer:
GUIDE is an 8-year Medicare demonstration program that started in 2024, providing coordinated dementia care through specialized teams that offer care planning, 24/7 support, caregiver education and training, respite care funding, and help accessing community resources, all at no additional cost to Medicare beneficiaries.
Understanding the program helps you access its benefits:
The basic structure
GUIDE tests whether comprehensive, person-centered dementia care delivered through specialized Dementia Care Programs (DCPs) can improve outcomes for both patients and caregivers while potentially reducing Medicare costs. The program runs through 2032 and operates nationwide through participating healthcare organizations. Medicare pays these organizations a monthly fee per enrolled patient to provide coordinated services, with higher payments for more complex care needs.
Core services provided
Interdisciplinary care teams include physicians, nurses, care navigators, social workers, and other specialists working together on your loved one's care. Comprehensive care planning addresses medical needs, behavioral symptoms, safety concerns, caregiver support, and community services. A 24/7 support line gives you access to help during crises, after hours, and on weekends when you can't reach regular providers. Care navigation connects you to community resources like transportation, meal delivery, adult day programs, and legal services. Regular monitoring and care coordination ensure all providers are working together and adjusting the care plan as needs change.
Caregiver-specific supports
The program recognizes that caring for someone with dementia is demanding and that supporting caregivers is essential to keeping patients at home. You receive free education and training on managing dementia symptoms, communication techniques, safety strategies, and self-care. Respite care funding up to $2,500 per year pays for services that give you breaks, including in-home respite care, adult day programs, or short-term facility stays. Caregiver assessments screen for your stress levels, health needs, and social support, with referrals for services when needed. Support groups and counseling may be available through some programs.
The two program tracks
The Established Track began in July 2024 for organizations already providing dementia care services, while the New Program Track launched services in July 2025 for organizations building new dementia care programs. As of January 2026, both tracks are fully operational with 327 participating organizations. The services provided are the same regardless of which track your provider joined.
2026 program focus
Recent expansions prioritize rural communities and underserved populations with historically limited access to dementia care. Safety-net providers serving low-income, dually eligible (Medicare and Medicaid), or minority populations receive technical assistance and support for building program infrastructure. Performance-based payments incentivize providers to achieve quality outcomes like reduced caregiver burden, fewer emergency room visits, and delayed nursing home placement.
Who is eligible for the GUIDE program?
Short answer:
Your loved one must have a dementia diagnosis, be enrolled in Medicare Part B, and not be living in a long-term nursing home to qualify. Family caregivers who provide regular unpaid assistance are eligible for caregiver supports once their loved one enrolls, with no restrictions on relationship, age, or whether the caregiver has Medicare.
Eligibility has requirements for both the person with dementia and the caregiver:
Requirements for the person with dementia
They must be enrolled in Original Medicare (Medicare Part B) or certain Medicare Advantage plans, though Medicare Advantage participation varies by plan and provider. They need a confirmed diagnosis of dementia at any stage, whether mild, moderate, or severe, including Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, or other types. They cannot be primarily residing in a long-term care nursing home, though assisted living, memory care, or living at home all qualify. People who are dually eligible for both Medicare and Medicaid are welcome and the program will coordinate both sets of benefits.
Requirements for caregivers
You must be an unpaid family member, friend, or other individual providing regular assistance with daily activities, medical care, or supervision. There are no restrictions on your relationship to the person with dementia; you can be a spouse, adult child, sibling, other relative, or close friend. You don't need to live with your loved one or provide care full-time to qualify. You can be any age and don't need to have Medicare yourself, though if you do have Medicare, you can access certain health screenings through the program. Multiple caregivers can be identified in the care plan if several people share responsibilities.
Priority populations
GUIDE specifically aims to serve underserved populations including people living in rural areas with limited healthcare access, individuals dually eligible for Medicare and Medicaid, racial and ethnic minorities who face healthcare disparities, and people receiving care from safety-net healthcare providers. If you fall into these categories, programs may have dedicated outreach and support.
How eligibility is confirmed
The participating Dementia Care Program conducts a comprehensive assessment to confirm your loved one's diagnosis, evaluate care needs, assess your situation as a caregiver, and determine what services would be most helpful. This assessment process typically takes one to two visits and covers medical status, cognitive function, behavioral symptoms, safety concerns, caregiver stress and burden, and available support systems.
What documents and information do I need to enroll?
Short answer:
Gather your loved one's Medicare card and number, medical records confirming dementia diagnosis, current medication list, your identification as the caregiver, Medicaid information if applicable, and emergency contact details before contacting a participating provider to begin enrollment.
Being prepared speeds the enrollment process:
Medical documentation
You'll need a physician's letter or records confirming the dementia diagnosis, recent medical records showing current health status and care needs, a complete list of all current medications with dosages and prescribing doctors, documentation of other medical conditions or chronic illnesses, and recent test results if available. The Dementia Care Program may request these directly from your loved one's doctors, but having copies expedites the process.
Insurance and financial information
Bring your loved one's Medicare card or have the Medicare number available. If your loved one has Medicare Advantage rather than Original Medicare, provide the plan information. Include Medicaid card and number if they're dually eligible. Note any supplemental insurance (Medigap) or long-term care insurance. While GUIDE services have no additional cost beyond regular Medicare, knowing your loved one's complete insurance picture helps with coordination. If you need to demonstrate financial need for certain community services, income and asset information may be requested.
Personal identification
Provide government-issued ID for your loved one such as driver's license or state ID. Have your own identification ready as the primary caregiver. If legal authority is needed for healthcare decisions, bring copies of healthcare power of attorney, guardianship papers, or other relevant legal documents. Proof of relationship isn't typically required but may be helpful in some cases.
Contact and emergency information
Create a list with your loved one's primary care doctor and all specialists including names, specialties, and contact information. Provide complete contact information for all family members or caregivers involved in care. List emergency contacts beyond the primary caregiver. Include pharmacy name, location, and phone number. Note any home health agencies or other services currently involved.
Care history information
Document recent hospitalizations or emergency room visits with dates and reasons. Note any current home health services or adult day program participation. List medical equipment or mobility aids currently used. Describe the home environment and any safety concerns. Provide information about your loved one's daily routines, preferences, and what assistance they currently need.
Keeping information organized
Many Dementia Care Programs use patient portals or online enrollment systems where you can upload documents. Consider creating a folder (physical or digital) with copies of everything related to your loved one's care. Keep a list of what documents you've provided and when. Update information as things change, particularly medications and medical conditions.
How does GUIDE actually work once you're enrolled?
Short answer:
After enrollment, an interdisciplinary care team creates a personalized care plan, provides regular check-ins and care coordination, gives you access to 24/7 support and caregiver training, and reimburses approved respite care expenses up to $2,500 annually, with the care plan updated regularly as needs change.
The program operates through coordinated services:
Building your care team
Once enrolled, you'll be assigned a care team that typically includes a care navigator or care coordinator who serves as your main contact, a physician or nurse practitioner overseeing medical care, a nurse providing clinical assessments and education, a social worker connecting you to community resources and providing counseling, and potentially other specialists based on needs like a pharmacist, behavioral health specialist, or dietitian. You'll meet your team members during the initial assessment and care planning process.
Creating the comprehensive care plan
The team develops a detailed, personalized care plan addressing your loved one's medical management including medication optimization and symptom control, behavioral and psychological symptoms with strategies for management, safety planning for home environment and wandering prevention, functional needs like mobility, bathing, and eating assistance, social and emotional wellbeing, and caregiver support including respite needs, training, and stress management. You participate actively in creating this plan, which reflects your loved one's preferences, values, and goals.
Ongoing care coordination
The care navigator maintains regular contact with you, typically at least monthly by phone or video, and more frequently if needs increase. The team coordinates among all your loved one's healthcare providers, ensuring everyone has current information and works toward shared goals. They help schedule and prepare for appointments, follow up on test results and specialist recommendations, adjust medications or treatments as needed, and anticipate problems before they become crises. When hospitalizations or emergency room visits occur, the team connects with hospital staff and helps with safe transitions home.
Accessing caregiver education and training
Programs offer various educational formats including one-on-one training sessions tailored to your specific situation, group classes on topics like dementia progression or communication strategies, online modules you can complete at your own pace, written materials and resources, and connections to community education programs. Training topics typically include understanding dementia and what to expect, managing challenging behaviors like agitation or wandering, effective communication techniques, daily care strategies for bathing, dressing, and eating, safety planning and fall prevention, and taking care of yourself as a caregiver.
Using the 24/7 support line
You receive a dedicated phone number to call anytime, day or night, when you need help. The support line is staffed by clinicians familiar with dementia care who can provide guidance during behavioral crises when your loved one is confused or agitated, answer medical questions that can't wait until morning, help you decide whether to go to the emergency room, provide emotional support during difficult moments, and connect you with local crisis resources if needed. Document the number and keep it easily accessible.
Accessing respite care
The program provides up to $2,500 per year to pay for respite services that give you breaks from caregiving. This can cover in-home respite where someone comes to your home to stay with your loved one while you rest or run errands, adult day programs where your loved one participates in activities while you have the day free, or short-term facility stays (respite care in a memory care or skilled nursing facility) for longer breaks. You work with your care team to identify appropriate respite services, arrange the service through approved providers, submit receipts or invoices for reimbursement, and receive payment either directly or through the provider. The care team helps you understand what's covered and navigate the reimbursement process.
Regular reassessments
Your loved one's condition and your needs as a caregiver are reassessed regularly, typically every six months or when significant changes occur. The care plan is updated based on these reassessments to reflect progression of dementia, new medical issues or medications, changes in care needs or home situation, increased caregiver burden or stress, and new goals or preferences. This ensures the support remains relevant and effective as the journey with dementia evolves.
What specific benefits does GUIDE provide to caregivers?
Short answer:
GUIDE reduces caregiver burden through education, respite funding, connection to resources, emotional support, health screenings for caregivers, and care coordination that prevents crises, with research suggesting these supports can significantly decrease caregiver stress and depression while improving quality of life.
The benefits directly address caregiver challenges:
Financial relief through respite
The $2,500 annual respite benefit provides meaningful financial support. If in-home respite costs $20-30 per hour, this covers 83 to 125 hours of breaks. If adult day care costs $75-100 per day, this funds 25 to 33 days of daytime respite. For short-term facility respite at $200-300 per day, this covers 8 to 12 days of longer breaks. This funding prevents caregiver burnout by making regular respite actually affordable rather than a luxury most caregivers can't access.
Reduced crisis and emergency situations
Proactive care planning and 24/7 access to support dramatically reduce emergency room visits and hospitalizations that are traumatic and exhausting for both patients and caregivers. When crises do occur, you have professional guidance rather than panicking alone. Coordinated medication management reduces adverse reactions and complications. Behavioral management strategies prevent or de-escalate challenging situations before they become unmanageable.
Knowledge and confidence
Many caregivers feel unprepared and uncertain about how to manage dementia symptoms or what to expect as the disease progresses. GUIDE education helps you understand what's happening, learn practical strategies that work, anticipate changes before they occur, communicate more effectively with your loved one, and feel more confident in your ability to provide good care. This knowledge reduces anxiety and helps you feel more in control.
Connection to comprehensive resources
Dementia care often requires services beyond medical treatment. Your care team connects you to meal delivery programs for adequate nutrition, transportation services for appointments, legal assistance for advance directives and planning, financial counseling for managing care costs, home safety evaluations and modifications, support groups for emotional connection with others, and community programs for social engagement. Navigating these resources alone is overwhelming; having a care navigator who knows what's available and helps you access it is invaluable.
Monitoring your own health and wellbeing
GUIDE recognizes that caregiver health matters. Programs assess your stress levels, mental health, physical health, and social support. If you're also a Medicare beneficiary, you can receive health screenings and referrals for your own care needs. The program encourages you to maintain your own medical appointments and addresses barriers to doing so. Some programs offer counseling or therapy referrals for caregivers experiencing depression or anxiety.
Improved care quality for your loved one
When your loved one receives better coordinated, more appropriate care, your caregiving becomes easier. Fewer medication side effects mean fewer complications you must manage. Better behavioral management means less stress at home. Proactive planning prevents crises that disrupt your life. Your loved one's improved quality of life directly benefits you as their caregiver.
Potential for delayed nursing home placement
Research on similar programs suggests that comprehensive dementia care can help people remain at home longer. This matters to families who prefer home care and want to delay or avoid facility placement. The combination of better medical management, caregiver support, and respite services makes home caregiving more sustainable.
Long-term program benefits
As the 8-year demonstration progresses through 2032, data will show whether GUIDE succeeds in its goals. If successful, the program may become permanent Medicare policy, expanding access to comprehensive dementia care nationwide. Early data from 2024-2026 suggests positive trends in caregiver satisfaction, reduced burden, and appropriate healthcare utilization.
How do I find and enroll in a GUIDE program?
Short answer:
Search for participating Dementia Care Programs at cms.gov/innovation/innovation-models/guide or call 1-800-MEDICARE, contact programs in your area to request enrollment, complete their assessment process, and work with them to develop your care plan, with the entire process typically taking one to three months from initial contact to full service access.
Finding and enrolling requires several steps:
Locating participating programs
Visit the CMS website at cms.gov/innovation/innovation-models/guide where you can search by state or zip code for participating Dementia Care Programs in your area. Call 1-800-MEDICARE (1-800-633-4227) and ask for information about GUIDE programs near you. Contact the Alzheimer's Association at 800-272-3900 or visit alz.org, as they maintain information about local programs and can help you navigate enrollment. Ask your loved one's primary care doctor if their healthcare system participates or if they can refer you to a participating program. Check with local hospitals, health systems, or senior service organizations about GUIDE participation.
Understanding program availability
As of January 2026, 327 organizations participate nationwide, but availability varies by location. Urban areas typically have more options than rural communities, though 2026 expansions are specifically targeting rural access. Some areas may have waiting lists if programs are at capacity. Medicare Advantage participation is more limited than Original Medicare, so check whether your loved one's specific MA plan works with available programs.
Making initial contact
Once you identify a participating program, call their GUIDE enrollment line or main number. Explain that you're interested in enrolling your loved one who has Medicare and dementia. Ask about their enrollment process, timeline, and any current waiting lists. Request information about what documents you'll need and how to prepare. Schedule an initial consultation or assessment appointment. Ask about virtual options if in-person visits are difficult.
The assessment process
The Dementia Care Program will schedule one or more assessment visits, which may be in-person at their office, in your home, or via telehealth depending on the program. During assessment, they'll review medical history and current health status, evaluate cognitive function and dementia severity, assess behavioral symptoms and care challenges, discuss your situation as a caregiver including stress and support needs, evaluate the home environment and safety concerns, and identify what services would be most beneficial. Be honest about challenges you're facing and what help you need most.
Completing enrollment
After assessment, if your loved one qualifies, you'll sign enrollment consent forms acknowledging participation in the GUIDE program. Review the care plan the team proposes and provide input on goals and priorities. Designate yourself and any other caregivers who should be included in the plan. Receive contact information for your care team and the 24/7 support line. Understand how to access services, particularly respite care and caregiver training. The program should explain any responsibilities you have for providing feedback or participating in reassessments.
Timeline expectations
From initial contact to full enrollment typically takes four to eight weeks. Assessment appointments may be scheduled two to four weeks out. Care plan development takes one to two weeks after assessment. Some services become available immediately upon enrollment, while others require setup time. Respite care may take additional time to arrange with approved providers. Be patient with the process while advocating for your needs if delays create hardship.
If enrollment is denied or delayed
If your loved one doesn't qualify, ask specifically why and whether circumstances might change. Inquire about waiting lists and how to be notified when space becomes available. Ask about alternative local dementia care resources. Contact the Alzheimer's Association or Area Agency on Aging for other support options. Consider whether a different participating program might have availability or different criteria.
How does respite funding actually work and what does it cover?
Short answer:
GUIDE provides up to $2,500 per calendar year for respite services, which you arrange through approved providers, submit receipts or invoices for reimbursement, and receive payment either directly or through the provider, with coverage including in-home care, adult day programs, and short-term facility stays that give caregivers breaks.
Understanding the respite benefit helps you use it effectively:
What qualifies as respite
In-home respite involves a trained caregiver coming to your home to stay with your loved one while you leave for appointments, errands, rest, or personal time. Adult day programs provide daytime care in a group setting with activities and supervision while you work or have time off. Short-term residential respite means temporary stays in a memory care facility or skilled nursing facility for several days, giving you an extended break for vacation, medical procedures, or urgent personal needs. Overnight respite at home with a caregiver staying through the night is covered by some programs.
What typically isn't covered
The respite benefit doesn't cover long-term care or permanent facility placement, regular home health or personal care aide services covered by other insurance, family members providing care (it must be paid services from providers), or services you're already receiving through Medicaid or other programs. The benefit is specifically for temporary respite to give caregivers breaks, not ongoing routine care.
How reimbursement works
Work with your care team to identify what type of respite would be most helpful and when. They'll provide information about approved respite providers in your area who meet quality standards. You arrange the service directly with the provider for the dates and times you need. Some programs use a voucher or authorization system where approval happens before service. Others use a reimbursement model where you pay initially and submit receipts. Keep all receipts, invoices, and documentation of services provided. Submit reimbursement requests through your Dementia Care Program, typically online through a portal or by mail. Reimbursement is processed within a timeframe specified by your program, usually two to four weeks.
Maximizing the benefit
Plan ahead to use the full $2,500 rather than saving it all for emergencies. Regular respite prevents burnout more effectively than occasional long breaks. Mix different types of respite: regular adult day program attendance provides ongoing relief, while short-term facility stays give you extended breaks periodically. In-home respite works well for shorter periods when you just need a few hours. Start using respite early in the year so you have the full benefit available. Track your spending to know how much of your annual allocation remains. Discuss with your care team if you're not sure how to best use the benefit.
Common respite challenges
Finding approved providers can be difficult in some areas, particularly rural communities. Your care team should help identify options. If your loved one resists respite or refuses to let you leave, work with the care team on strategies to make transitions smoother. Try shorter respite periods initially to build acceptance. Some programs have limited provider networks; ask if out-of-network providers can be approved if necessary. Processing reimbursements can be slow; budget accordingly rather than relying on immediate repayment.
Can GUIDE work with other programs and benefits I'm already using?
Short answer:
Yes, GUIDE coordinates with Medicaid, VA benefits, long-term care insurance, and other services rather than replacing them, though you cannot receive duplicate payment for the same service from multiple sources, and the care team helps navigate how different benefits work together.
Coordination maximizes available support:
GUIDE and Medicaid
People dually eligible for Medicare and Medicaid can participate in GUIDE. The program coordinates medical services covered by Medicare with home and community-based services covered by Medicaid. Your GUIDE care team works with your Medicaid care manager to align plans and avoid duplication. Medicaid may cover personal care services that extend beyond GUIDE respite funding. The two programs complement rather than compete with each other.
GUIDE and VA benefits
Veterans with dementia can participate in GUIDE while receiving VA healthcare. The programs coordinate to avoid duplicate services. GUIDE may provide caregiver supports not available through VA, or vice versa. Your care team communicates with VA providers to ensure comprehensive coordinated care. You cannot receive respite funding from both GUIDE and VA programs for the same service.
GUIDE and long-term care insurance
If your loved one has long-term care insurance, GUIDE complements those benefits. Long-term care insurance typically covers daily care services, while GUIDE focuses on care coordination and caregiver support. Respite paid by GUIDE may be separate from long-term care insurance benefits, but check policy specifics. Your care team can help you understand how to maximize both benefit sources.
GUIDE and Medicare Advantage
GUIDE participation with Medicare Advantage plans is more limited than with Original Medicare. Some Medicare Advantage plans participate in GUIDE while others don't. Check with both your MA plan and potential GUIDE programs about participation. If your MA plan doesn't participate, switching to Original Medicare during open enrollment may give you access to GUIDE.
GUIDE and hospice
If your loved one transitions to hospice care, GUIDE enrollment typically ends because hospice provides comprehensive care coordination. However, your GUIDE care team can help facilitate the transition to hospice when appropriate. Some of the relationships and resources developed through GUIDE may continue to be helpful even after enrollment ends.
Avoiding duplication
You cannot receive payment from multiple sources for the same service at the same time. For example, you can't use GUIDE respite funding for services already paid by Medicaid. Be transparent with your care team about all benefits and services you're receiving. They'll help you understand how to use each benefit source appropriately and maximize total available support.
What challenges or limitations should I be aware of with GUIDE?
Short answer:
GUIDE availability is limited to participating organizations that may not exist in all areas, enrollment can involve waiting lists, respite provider availability varies, the program is temporary through 2032, and effectiveness depends on your care team's quality and your active participation.
Being realistic helps set appropriate expectations:
Geographic availability
Not all areas have participating GUIDE programs yet, particularly small rural communities or areas with limited healthcare infrastructure. Even in areas with participating programs, you may have limited choices of providers. The distance to the nearest participating program may be significant, making in-person visits challenging. 2026 expansions are targeting these gaps, but availability remains uneven. If no GUIDE programs exist in your area, contact the Alzheimer's Association about alternative local resources.
Enrollment wait times and capacity
Some programs have reached capacity and maintain waiting lists for new enrollment. From initial contact to full service access typically takes one to three months under ideal circumstances. Assessment and care plan development require time and cannot be rushed. High-demand programs may prioritize certain populations like those at immediate risk of nursing home placement. Being persistent and following up regularly can help move you through the process.
Respite provider availability
The $2,500 respite benefit is only valuable if you can find approved providers. Some areas have limited adult day programs or in-home respite agencies. Quality respite providers may have their own waiting lists or limited availability. Your loved one may refuse certain providers or settings, limiting practical options. Approved provider networks may be restrictive, reducing flexibility. Work closely with your care team to identify all possible respite options.
Program is time-limited
GUIDE is an 8-year demonstration ending in 2032, not a permanent Medicare benefit. If the program proves successful, it may become permanent policy, but this isn't guaranteed. Planning long-term care strategies around GUIDE availability involves some uncertainty. If GUIDE ends, you'll need to identify alternative support sources. However, the care planning, education, and connections you develop through GUIDE provide lasting value regardless.
Variable program quality
Like any program involving multiple organizations, quality varies among participating Dementia Care Programs. Some have more experienced teams, better resource networks, or more responsive service. The care coordinator you're assigned significantly impacts your experience. If you're dissatisfied with your program, you may be able to switch to another participating program if alternatives exist. Providing feedback to your program about what's working and what isn't helps them improve.
Requires active caregiver participation
GUIDE benefits are greatest when caregivers actively engage with the program. You need to maintain communication with your care team, attend training and education sessions, follow through on care plan recommendations, track and submit respite reimbursements, and provide feedback about what's helping. If you're too overwhelmed to participate actively, the benefits diminish. Communicate with your care team when you're struggling to engage so they can adjust their approach.
Medical complexity may limit benefits
People with dementia plus multiple complex medical conditions may need care beyond what GUIDE can coordinate. End-stage dementia may be better served by hospice than GUIDE. People with severe behavioral symptoms may need psychiatric care beyond program capacity. GUIDE is designed for community-dwelling dementia patients who can potentially remain at home with appropriate support, not for all dementia situations.
How CareThru complements GUIDE enrollment and services
Participating in the Medicare GUIDE program involves coordinating with a care team, tracking appointments and services, managing multiple providers, keeping family members informed, organizing medical records, and accessing various community resources. The program provides excellent support, but you still need to manage the logistics of your loved one's complex care.
CareThru creates the organizational foundation that makes GUIDE participation more effective. When your GUIDE care coordinator asks about your loved one's current medications, appointments with specialists, or recent symptom changes, you have complete, accurate information immediately accessible rather than trying to remember or search through scattered papers. The comprehensive medication list, appointment calendar, and care notes in CareThru give your care team the clear picture they need to develop the most effective care plan.
As your GUIDE team coordinates various services and providers, CareThru helps you track all the moving pieces. You can document when the respite care provider comes, what activities your loved one attended at adult day care, which training sessions you've completed, and what recommendations came from your last care team check-in. This organized record ensures you don't lose track of valuable supports or miss opportunities to access benefits.
Respite care reimbursement requires submitting receipts and documentation. CareThru's document storage lets you photograph or scan respite provider invoices, keep a running total of your respite spending against the $2,500 annual limit, store reimbursement confirmations, and maintain organized records for tax purposes if respite costs qualify as medical expenses. You know exactly how much of your respite benefit remains available and have all documentation ready when submitting reimbursement requests.
The GUIDE program involves regular reassessments and care plan updates. Having a detailed record of the past months in CareThru provides concrete information for these conversations. Rather than vague recollections, you can show your care team specific patterns: that challenging behaviors occur primarily in late afternoon, that certain medications seem to worsen confusion, that emergency room visits happen when particular symptoms appear, or that your stress levels increase during weeks without respite. This documentation makes reassessments more productive and care plans more targeted.
When GUIDE connects you to community resources like adult day programs, meal delivery, or support groups, CareThru helps you track contact information, schedules, and your experiences with each resource. You build a comprehensive resource list that remains valuable even after GUIDE enrollment ends. Family members can access this same information, ensuring everyone knows what services are involved and how to contact providers.
The GUIDE program specifically addresses caregiver burden and stress. CareThru supports this goal by reducing the mental load of organization and coordination. When everything is documented and accessible, you spend less cognitive energy trying to remember details or find information. When family members can see your loved one's schedule and care needs in CareThru, they can offer specific help rather than vague support. This organizational structure, combined with GUIDE's respite and education, creates comprehensive support for sustainable caregiving.
Frequently Asked Questions About the Medicare GUIDE Model
Does GUIDE cost anything or is it covered by Medicare?
GUIDE services have no additional cost to Medicare beneficiaries beyond standard Medicare premiums and cost-sharing. Medicare pays participating Dementia Care Programs a monthly per-patient fee to provide comprehensive coordinated care, caregiver supports, and respite funding. You don't pay enrollment fees, service fees, or copays for GUIDE-specific services like care coordination, caregiver training, or 24/7 support line access. However, you still pay standard Medicare costs for doctor visits, medications, and other medical care. The $2,500 respite benefit is paid by the program, not by you.
Can family caregivers get paid for providing care through GUIDE?
No, GUIDE does not provide direct payment to family caregivers for the care they provide. The respite benefit pays for professional respite services from agencies or facilities to give family caregivers breaks, but family members cannot bill GUIDE for their own caregiving time. If you need paid family caregiver options, explore Medicaid self-directed programs or VA benefits, which may allow payment to family members in some states. GUIDE focuses on supporting unpaid family caregivers rather than compensating them.
What happens if my loved one gets hospitalized while enrolled in GUIDE?
Your GUIDE care team stays involved and helps coordinate care during and after hospitalization. Contact your care coordinator or the 24/7 support line when hospitalization occurs. The team may communicate with hospital staff to provide care history and recommendations, help plan safe discharge from hospital to home, coordinate post-hospitalization services and appointments, adjust the care plan based on new medical needs, and provide extra support during the recovery period. Enrollment in GUIDE continues during hospitalizations.
Is GUIDE only for Alzheimer's disease or does it cover other types of dementia?
GUIDE covers all types of dementia including Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, mixed dementia, Parkinson's disease dementia, and other forms. The key requirement is a confirmed dementia diagnosis, regardless of the specific type. The program serves people at all stages of dementia from mild cognitive impairment through severe dementia, with services tailored to current care needs.
Can I enroll in GUIDE if my loved one lives in assisted living or memory care?
Yes, people living in assisted living or memory care facilities can enroll in GUIDE as long as they're not in a long-term care nursing home. The program considers assisted living and memory care as community-dwelling settings. Your GUIDE care team coordinates with facility staff to ensure comprehensive care. The respite benefit might be used differently in facility settings, perhaps funding occasional higher-level care days or giving you breaks from visiting and providing supplemental care. Discuss with the program how GUIDE services work best in your specific living situation.
What if there's no GUIDE program in my rural area?
The 2026 expansions specifically prioritize rural access, with technical assistance and support for rural providers building GUIDE programs. Contact 1-800-MEDICARE to check the most current list of participating programs and ask about any new programs developing in your region. Even if no local program exists yet, register your interest so CMS knows demand exists in your area. In the meantime, contact your Area Agency on Aging at 800-677-1116 for local dementia care resources that may provide similar supports. Telehealth options through some GUIDE programs may help bridge geographic gaps.
How does GUIDE compare to hospice for end-stage dementia?
GUIDE and hospice serve different purposes and aren't typically used simultaneously. GUIDE focuses on comprehensive dementia care throughout the disease course, supporting home caregiving and managing symptoms while your loved one still has months or years of life expectancy. Hospice becomes appropriate when dementia reaches end-stage with life expectancy of six months or less, shifting focus entirely to comfort care. You can transition from GUIDE to hospice when appropriate. GUIDE may help you recognize when hospice is suitable and facilitate that transition. Some families wish they'd had GUIDE earlier and hospice sooner, as both programs offer valuable supports at different disease stages.
Will participating in GUIDE affect my loved one's other Medicare benefits or coverage?
No, GUIDE enrollment doesn't change or reduce other Medicare benefits. Your loved one still has access to all standard Medicare Part B services, medications through Part D, preventive care, specialist visits, hospitalizations, and any other Medicare-covered services. GUIDE adds coordinated care and caregiver supports on top of regular Medicare. The only limitation is that you cannot receive duplicate payment from both GUIDE and another source for the exact same service at the same time.
Sources
This article was developed using information from the following trusted sources:
- Centers for Medicare & Medicaid Services. (2025). "GUIDE Model: Guiding an Improved Dementia Experience." Available at cms.gov/innovation/innovation-models/guide
- CMS Innovation Center. (2024-2026). "GUIDE Model Fact Sheets and Updates." Available at innovation.cms.gov
- Medicare.gov. (2025). "Medicare Coverage of Dementia Care Services." Available at medicare.gov
- Alzheimer's Association. (2025). "Understanding the GUIDE Model." Available at alz.org
- National Institute on Aging. (2024). "Medicare Coverage for Dementia Care." Available at nia.nih.gov
- Family Caregiver Alliance. (2025). "Dementia Care Programs and Medicare Benefits." Available at caregiver.org
- AARP. (2025). "New Medicare Dementia Care Programs." Available at aarp.org
- Administration for Community Living. (2025). "Dementia Care Resources." Available at acl.gov
- The Gerontologist. (2024). "Evaluating Comprehensive Dementia Care Models."
- Journal of the American Medical Association. (2024). "Medicare Payment Models for Dementia Care."
Informational disclaimer:
This article provides general information about the Medicare GUIDE model as of January 2026 and is not official guidance or legal advice. GUIDE is a demonstration program that may change as it evolves through 2032. Eligibility criteria, services, and participating organizations should be verified directly with CMS at cms.gov/innovation/innovation-models/guide or by calling 1-800-MEDICARE. Individual circumstances vary significantly. Consult with your healthcare providers, the Alzheimer's Association, or Medicare counselors for guidance specific to your situation.