Received a Medicare GUIDE letter? What it means and your next steps

Received a Medicare GUIDE letter? What it means and your next steps.

Short answer: Receiving a Medicare GUIDE letter means Medicare believes your family may qualify for dementia support at no cost. GUIDE is a national program that helps families get organized care at home, education for family and unpaid caregivers, and a way to reach help any time. Eligible families may also receive a set number of respite care hours each year, allowing caregivers time to rest while care is provided. Participation is voluntary and your regular Medicare benefits do not change.

What is GUIDE?

GUIDE (Guiding an Improved Dementia Experience) is a Medicare program designed to provide comprehensive, coordinated support for people with dementia and their unpaid caregivers, aiming to improve quality of life, reduce caregiver burden, and help individuals stay at home longer. Support includes care navigation, caregiver education, and respite services, available at no cost for eligible Medicare beneficiaries through participating providers.

Why did I get this letter?

Medicare used information such as your zip code and a recent dementia diagnosis in claims to identify households that may qualify. The letter points you to organizations that can help you learn more and get started if you are eligible.

Quick eligibility at a glance

• You have Alzheimer’s disease or another dementia. If a diagnosis has not been documented, PocketRN can help you take the right steps to obtain one.
• You are enrolled in Traditional Medicare Parts A and B.
• You live at home, in independent living, or in assisted living.
• You are not currently on hospice and you are not a resident in a skilled nursing facility. Short term rehabilitation stays are okay.

Good to know

• Veterans receiving VA care can be eligible.
• People with both Medicare and Medicaid can be eligible.
• Individuals receiving memory care or palliative care can be eligible.

GUIDE is voluntary and does not change your Medicare benefits. There is no cost to participate for eligible Medicare beneficiaries and no obligation to join.

What support can families receive?

• A dedicated care navigator who helps create and update a simple plan
• Help coordinating appointments and connecting to community resources
• Twenty four seven access to support when questions come up
• Education for caregivers that fits real life and is available in multiple languages
• Respite for eligible family/unpaid caregivers within a yearly allowance (Around 72 hours per year)

Does GUIDE change my Medicare?

No. GUIDE is voluntary. You can keep seeing your current doctors, health care providers, and hospitals. There is no cost to participate for eligible Medicare beneficiaries and no obligation to join.

How PocketRN helps

PocketRN is an approved GUIDE participant and provider of services nationwide. We partner with home care agencies so support reaches you where life happens most. Our Nurse For Life model pairs your family with a dedicated nurse who knows your story, checks in regularly, and coordinates with physicians, specialists, and community resources. When something changes, you have a nurse to call who understands your routine and priorities.

What to expect when you enroll in GUIDE with PocketRN

1. A welcome call to learn your goals and daily routines
2. A comprehensive assessment and a simple, shared plan
3. Regular check ins plus on demand access when you need help
4. Coaching and education for the family/unpaid caregiver, with follow up so learning turns into action
5. Support with eligible respite and connections to community services

GUIDE common questions

Do I have to pay?‍

There is no cost for eligible Medicare beneficiaries.

Do I have to switch doctors?‍

No, you will keep your existing doctors. We coordinate with your current care team.

Who qualifies for the home care (respite) benefit?

‍To qualify for the annual respite benefit, the person living with dementia must have moderate to severe dementia and an identified family or unpaid caregiver. The caregiver does not need to live with the person. Final eligibility is determined through a participating provider’s assessment under Medicare guidance. 

How many hours of respite care are available to me?

For qualifying families, respite is available on a yearly basis and resets each year on July 1. For the current program year (July 1, 2025 through June 30, 2026), eligible families can receive up to 72 hours of in-home respite care. The number of hours may change in future years based on Medicare guidelines.

Is this the same as home health or hospice?‍

No. GUIDE is different. It focuses on ongoing dementia support and caregiver help. It can be used alongside your existing care.

What if we do not have a formal dementia diagnosis yet?‍

Tell us during the welcome call. We can help you through  next steps to obtain the appropriate evaluation.

How to take the first step

Have your Medicare card handy. Then contact PocketRN at 872-233-4490 to confirm eligibility, schedule your welcome call, and begin building a plan that fits your day to day life.