GUIDE dementia care
Support for people living with dementia and the family caregivers who care for them. GUIDE is a Medicare program, and Bay Health Solutions is part of it.
Have the Medicare number ready when you call. It lets us check eligibility right away.
What GUIDE offers
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A personal care plan
Built with you after a full assessment of needs at home.
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A care navigator
One person who knows your situation and helps you find your way.
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A 24/7 help line
Reach a care team member day or night, every day of the year.
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Caregiver support and respite
Education for caregivers and respite care, which means a break for the caregiver.
What you and your caregiver receive
- A full assessment and a personal care plan.
- A care navigator who knows you and your family.
- Ongoing check-ins and support from a care team.
- A help line you can call 24 hours a day, 7 days a week.
- Education and support for family caregivers.
- Respite care: in-home help, adult day centers, or short stays in a 24-hour facility, up to a yearly limit. People with moderate to severe dementia may qualify for respite valued at up to $2,625 per year.
- Connections to community services such as meals and transportation.
Your Medicare stays the same
GUIDE does not change your Medicare benefits. You keep your own doctors and specialists, and you can see any doctor or hospital that accepts Medicare. Joining is voluntary, and you can leave the program at any time.
Who can join
You may qualify for GUIDE if you:
- Have a dementia diagnosis. If dementia is suspected but not confirmed, we can help you get a diagnosis.
- Have Medicare Parts A and B as your main insurance. People with both Medicare and Medicaid can qualify.
- Are not enrolled in a Medicare Advantage plan (including Special Needs Plans) or in PACE.
- Are not enrolled in Medicare hospice care.
- Are not living in a nursing home long term.
Not eligible? Call us anyway. We can connect you with other services for people living with dementia and their caregivers.
How to join
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Call the GUIDE intake line
Call 800-493-0238 with the Medicare number ready. We check eligibility on the call.
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Meet with the care team
A care team member does an assessment with you, in person or by video.
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Get confirmation
The care team sends your information to Medicare and lets you know when you're enrolled.
GUIDE contacts
Phone: 804-758-2386
Email: guide@bayaging.org
For doctors and clinicians making a referral: 804-286-9202, extension 1337.
Common questions
Will I have to change doctors?
No. You keep your primary care provider and your specialists. GUIDE adds a care navigator and a care team who work alongside them.
Does GUIDE affect my other Medicare benefits?
No. Your Medicare benefits stay the same, and you can still see any doctor or hospital that accepts Medicare.
What if my loved one doesn't have a diagnosis yet?
Call us. If dementia is suspected but not confirmed, we can help arrange an evaluation so you can find out whether GUIDE is a fit.
I'm in a Medicare Advantage plan. Can I join?
Not while you're enrolled in Medicare Advantage. Call us anyway. We can connect you with other dementia care and caregiver support services.
Can we leave the program later?
Yes. Joining is voluntary, and you can stop at any time.
Learn more
- Read the Medicare GUIDE fact sheet for patients and caregivers (PDF)
- Watch an introduction to GUIDE for caregivers and families (video on Vimeo)
- Watch an introduction to GUIDE for clinicians and care teams (video on Vimeo)
Bay Aging, one of our two partner agencies, is one of fewer than 400 organizations nationwide chosen to provide GUIDE. In 2026 it received the USAging Aging Achievement Award for its GUIDE Model program.
Get help with GUIDE
You don't have to navigate dementia care alone. Call the GUIDE intake line and we'll help you understand your options and find out whether GUIDE may be right for you or someone you love.