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The GUIDE Model
for Dementia Care
Guiding an Improved Dementia Experience. A CMS innovation model providing comprehensive, coordinated dementia care at no additional cost through traditional Medicare. Your trusted partner at every stage of the journey.
Is Your Loved One Eligible?
The GUIDE Model is available to Medicare beneficiaries who meet the following criteria:
Dementia Diagnosis
Has been diagnosed with Alzheimer's disease or a related dementia by a qualified clinician.
Traditional Medicare
Enrolled in Medicare Parts A & B. Not enrolled in a Medicare Advantage plan, PACE program, or hospice.
Not in a Long-Term Nursing Home
Does not reside in a long-term skilled nursing facility. Assisted living facilities are accepted.
Medicare as Primary Payer
Medicare must be the patient's primary health insurance payer for GUIDE Model services.
GUIDE Model Support & Services
Our physician-led GUIDE team delivers seven core services, covered under traditional Medicare:
Care Navigation
A committed Care Navigator collaborates with the clinical team to manage communication, appointments, and medication, plus referrals to community services.
Care Management
An interdisciplinary team develops a customized care plan that includes ongoing monitoring and regular updates tailored to the patient's stage of dementia.
Respite Services
Caregivers could qualify for respite care services to help prevent burnout and maintain their own health.
Caregiver Education
A program for caregivers that offers training, education, and support, with Care Navigators available to coordinate clinical and non-clinical resources.
24/7 Support
Beneficiaries and caregivers will reach a care team member or navigator through a 24/7 helpline for assistance at any hour of the day or night.
Training
Instant access to educational classes, content, and support groups covering topics related to dementia care — for both patients and their families.
Medication Management
The clinical team frequently evaluates prescribed medication as necessary, with navigators offering guidance on medication schedules and safety.
Caregiver burnout is one of the most serious challenges in dementia care. The GUIDE Model's respite benefit provides real financial relief so family caregivers can rest and recover.
Check Your EligibilityWho Respite Benefits Help
- Spouses providing daily care at home
- Adult children managing care from a distance
- Families managing behavioral symptoms
- Caregivers at risk of their own health decline
How to Enroll in the GUIDE Model
Enrollment is simple. Our GUIDE Ambassadors guide families every step of the way.
Contact a GUIDE Ambassador
Eligibility Review
Consent & Enrollment
Meet Your Care Navigator
Care Begins
Contact a GUIDE Ambassador Today
Our GUIDE Ambassadors are dedicated staff who specialize in helping families understand and enroll in the GUIDE Model. They answer questions about eligibility, what to expect, and how care is delivered.
There is no cost to call and no commitment required. We are here to help your family navigate dementia care with confidence and compassion.
GUIDE Model FAQ
GUIDE Model services are covered under traditional Medicare at no additional cost beyond normal Medicare cost-sharing. Patients do not need a supplemental plan, though one may reduce out-of-pocket costs further.
Yes. Assisted living facility residents are eligible for the GUIDE Model. The program is not available to patients residing in long-term skilled nursing facilities, but home and ALF settings are both accepted.
The GUIDE Model currently requires traditional Medicare (Parts A & B) as the primary payer. Patients on Medicare Advantage or PACE plans are not eligible. Call our team at (321) 235-0692 to discuss your specific situation.
All types of dementia qualify, including Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed dementia, provided the diagnosis is documented and Medicare eligibility requirements are met.
Once enrolled, patients and caregivers receive a direct helpline number staffed around the clock by trained dementia care professionals. The number is provided at enrollment and is available for urgent clinical questions, behavioral crises, or general support at any time.
The GUIDE Model is a comprehensive, coordinated care program specifically designed for dementia patients. In addition to medical visits, it includes a dedicated Care Navigator, caregiver education and respite services, 24/7 access, and structured community resource connections — none of which are part of a standard home visit arrangement.
Your Trusted Partner in Dementia Care
Our GUIDE Ambassadors are ready to answer your questions, confirm eligibility, and walk your family through enrollment — at no cost to you.
Or email us directly at guide@hpg.health