If you or a loved one are experiencing memory concerns—or navigating a dementia diagnosis—you don’t have to do it alone. Through Medicare’s
GUIDE model (Guiding an Improved Dementia Experience), your trusted community partners provide doctor-guided brain care navigation that brings personalized support, caregiver guidance, and community-based coordination into everyday life.
The Medicare GUIDE Program (Guiding an Improved Dementia Experience) is a new national Medicare initiative designed to support people living with dementia—and the caregivers who care for them—between doctor visits. Through GUIDE, support is delivered locally through trusted community organizations—including community pharmacies, community health organizations, and mobile health teams — where people already feel comfortable and supported. These local partners serve as welcoming access points for care navigation, helping families manage memory concerns, medications, daily routines, safety, and caregiver stress.
GamePlan Medical doctors work behind the scenes to provide medical oversight, training, and coordination, ensuring that care navigation remains clinically sound, compassionate, and well-connected to a patient’s broader medical care. We don’t replace your current doctors. Your primary care provider or neurologist remains your trusted clinician — GUIDE simply adds a layer of community-based support so no one has to navigate dementia alone.
Dedicated Care Navigator to help you access all necessary services, from clinical care to community support.
GUIDE-eligible patients face no out-of-pocket charges for our services.
With up to $2,500 annually for respite care, allowing caregivers to recharge.
Receive round-the-clock support and answers to urgent questions from a dedicated care team.
Personalized care planning addressing medical, behavioral, and functional needs to ensure holistic well-being.
Gain access to evidence-based training and resources designed to reduce caregiver strain and empower your role.
Brain Care Navigation is how the Medicare GUIDE Program supports you day to day. A trained Care Navigator checks in regularly to help with memory concerns, medications, safety at home, daily routines, caregiver stress, and connecting to helpful community resources. Care Navigators are guided by doctors who specialize in helping people function better and work closely with your local community organizations to provide you with extra support between doctor visits.
Through Medicare’s GUIDE program, GamePlan Medical provides ongoing, doctor-guided support between traditional doctor visits—so families are not left to figure things out on their own. After an initial assessment, a physician-led team matches you with a specially trained care navigator who
provides regular check-ins, guidance, and practical help with daily life. This includes support with memory concerns, medications, safety at home, daily routines, and caregiver stress—always focused on helping people stay independent and confident for as long as possible.
Care Navigators are trusted community team members, supported by trusted local organizations and guided by doctors who specialize in helping people function better as they age.
To be eligible for the GUIDE program at GamePlan Medical, our team will assist with checking whether you meet specific Medicare requirements.
Memory loss that is effecting daily life
Medicare serving as their primary payer.
Enrollment in Original Medicare Parts A and B (individuals enrolled in Medicare Advantage, including Special Needs Plans, or PACE programs are generally not eligible).
Currently residing in a long-term nursing home. (Assisted living facilities are usually accepted).
Currently enrolled in Medicare hospice benefit.
The Guiding an Improved Dementia Experience (GUIDE) Model is a voluntary nationwide program led by the Centers for Medicare & Medicaid Services (CMS). It aims to provide comprehensive, coordinated dementia care to support people living with dementia and their unpaid caregivers, helping to improve quality of life, reduce caregiver strain, and enable individuals to remain in their homes and communities longer.
Eligibility typically requires a confirmed dementia diagnosis, enrollment in Original Medicare Parts A and B (not Medicare Advantage or PACE), Medicare as your primary payer, not residing in a long-term nursing home, and not currently enrolled in Medicare hospice benefit. To enroll, your GUIDE provider will explain the program and, with your agreement, will file the necessary paperwork with Medicare. Participation is voluntary. We encourage you to contact GamePlan Medical directly to confirm your specific eligibility.
The GUIDE Model is designed as an additional Medicare benefit and does not conflict with other Medicare benefits. While standard Medicare deductibles and copayments for covered services would still apply, the GUIDE program itself aims to provide enhanced services and support without additional direct program costs to the beneficiary. Respite services, for eligible caregivers, are covered up to an annual cap of $2,500.
GUIDE significantly improves access by providing a dedicated interdisciplinary care team and a Care Navigator to coordinate care and connect patients and caregivers to both clinical and non-clinical services (like meals and transportation). It offers 24/7 access to a support line, caregiver education and training, and respite services. This comprehensive support helps reduce barriers to care, alleviates stress, and enables patients to remain safely in their homes for longer.
While the CMS GUIDE program has specific application tracks for organizations to become official participants, GamePlan Medical is already an approved participant. We actively collaborate with primary care providers who wish to enroll their eligible Medicare beneficiaries into the GUIDE program through our established participation. This allows you to offer your patients the benefits of GUIDE without needing to apply directly to CMS as a separate GUIDE participant.
By partnering with GamePlan Medical for the GUIDE program, primary care providers can offer their eligible patients comprehensive, coordinated dementia care without altering their existing patient relationships. You remain the trusted primary care provider, while GamePlan Medical delivers specialized dementia support. This collaboration allows you to enhance your patient care offerings, potentially improve patient outcomes and satisfaction, and streamline the process of accessing specialized dementia services for your patients, all while leveraging an established CMS-approved program.