Alzheimer’s, which is the most common form of dementia, is a challenging disease that is tough for the person affected, as well as those around them. It can start with memory loss and lead to the person having to be watched 24-7 in a skilled nursing facility for their personal safety.
Currently, more than 5 million Americans have Alzheimer’s, and with a large aging population, that number is only expected to grow. The most recent data shows that 11% of Medicare beneficiaries have been diagnosed with Alzheimer’s disease; these beneficiaries are more common than those with asthma, cancer, and osteoporosis.
Let’s take a look at what is and what is not covered under Medicare and learn what Medicare supplement insurance is, which can take care of all the other costs associated with the disease.
ALZHEIMER’S AND ORIGINAL MEDICARE COVERAGE
Alzheimer’s patients receive a lot of financial support from Original Medicare when it comes to things like doctor’s visits, part-time skilled nursing care, at-home physical therapy, hospice care, and diagnostic testing.
Medicare will give Alzheimer’s patients nursing home coverage for a registered nurse, physical therapist, or a licensed practical nurse. It will also pay for up to 100 days of skilled nursing home care under limited circumstances.
Medicare covers inpatient hospital care and some of the doctors’ fees and other medical items for people with Alzheimer’s or dementia who are age 65 or older as well.
Fortunately, under a new health law, Original Medicare will now cover doctors’ screenings for cognitive impairment. During such a test, a doctor will look at a patient’s medical history, do a neurological and physical examination, conduct blood tests, do brain imaging and test a patient’s mental functions. Once the person is diagnosed, they can begin to receive early treatment of their Alzheimer’s.
Medicare steps up to help when a person is in the late stages of Alzheimer’s and needs 24-hour care, though the coverage can be spotty and may need to be supplemented with care from family members. Medicare will also only pay for 100 days of nursing home care, and it has to happen following a stay in a hospital. For example, if an Alzheimer’s patient breaks a leg and needs to be admitted into the hospital, they will be covered for 100 days of care.
It will cover up to 35 hours a week of home health care for someone who is “home bound,” meaning they cannot mentally function outside of the home without someone helping them.
There is a hospice benefit provided by Medicare as well. If someone has less than six months to live, they will be covered. It will pay for nurses, doctors, prescription drugs, personal care, counseling, and homemaker services.
Many people feel the onset of Alzheimer’s before age 65, but if someone gets it earlier, they may qualify for early Medicare coverage. They might also be eligible for Social Security Disability Insurance if they can no longer work because of their Alzheimer’s. If Social Security Disability Insurance covers them for 24 months because of Alzheimer’s, they will become eligible to enroll in Medicare.
However, Original Medicare does not cover prescription drugs (like Cholinesterase or memantine), caregiving support (from an unpaid family member) and long-term care (like bathing, using the bathroom and eating). It also won’t offer benefits for supervision or personal care either at home or in memory care facilities. Alternative therapies like herbal medicine and acupuncture are also not covered.
If you’re asking yourself what is Medicare Supplement insurance and how it can help someone with Alzheimer’s, keep reading.
WHAT IS MEDICARE SUPPLEMENT?
If you’re wondering, “What is Medicare Supplement insurance?”it’s an insurance plan that covers specific out-of-pocket healthcare costs that Original Medicare, Part A and Part B do not cover. Medicare Supplement is also known as Medigap or MedSupp.
In most states, consumers will be able to access 10 different plans. They each have a letter and include various upsides and downsides. For instance, one may cover a type of surgery that another does not. Usually, the states have standardized the plans, so what is covered in New Jersey under Medicare Supplement Plan G, for example, would also be covered in Massachusetts under Medicare Supplement Plan G.
When researching what is Medicare Supplement insurance, you’ll find that the 10 Medicare Supplement plans are labeled A, B, C, D, F, G, K, L, M, and N. Here are some of the benefits, along with which plans cover them.
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up are covered by every plan.
- Blood (first 3 pints) is covered by every plan except for K (only 50%) and L (only 75%)
- Skilled nursing facility care coinsurance is not covered by A and B, is 50% covered by K, 75% covered by L and fully covered by the rest
Note that starting on January 1, 2020, you will no longer be able to purchase Medicare Supplement Plans F and C. However, if you have them already, you will be able to keep them going forward.
Now that you know what Medicare Supplement insurance is, let’s take a look at the rules and coverage under certain plans.
RULES AND COVERAGE FOR ALZHEIMER’S UNDER MEDICARE SUPPLEMENT
When researching Medicare Supplement insurance, you may come across the fact that if you have Alzheimer’s, you cannot purchase a Medicare Supplement plan. This is not entirely true. If the plan is a Guaranteed Issue product, you can sign up for Plans A, B, C, or F without having to pass medical underwriting. A GI situation may apply to someone who is in a Medicare Advantage Plan but moves out of a plan’s service area, or someone with an employer group health plan that is expiring. Then, they have a 63-day window to choose a plan.
Note: A majority of underwriters will do a phone interview as part of their screening process, and it may involve a cognitive test. If someone fails, they may not be able to receive coverage for their Alzheimer’s. It can be very tricky to cover someone for Alzheimer’s, so it is best to do yearly cognitive screenings at age 65 (or earlier) to ensure that the person diagnosed receives the coverage they need.
If you’re wondering what is the best Medicare Supplement insurance plan for Alzheimer’s that is considered the best, you have many options. While it’s ultimately up to you and your specific situation, the option that many people choose is Medicare Supplement Plan D, because it provides benefits for many prescription drugs that are essential to an Alzheimer’s patient’s care.
Plan D will also cover: Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up, Part B coinsurance or copayment, Blood (first 3 pints), Part A hospice care coinsurance or copayment, Skilled nursing facility care coinsurance, Part A deductible and 80% of Foreign travel exchange (up to plan limits). Note that it does not cover the Part B deductible or Part B excess charge. Medicare Supplement Plan D is considered the midway between the least and most Medicare coverage, since it covers most things but not Part B.
Another great option is Medicare Supplement Plan F, which is the most comprehensive Medigap plan, along with Medicare Supplement Plan C, which includes everything but the Part B excess charge. The downside is that a patient must enroll by that 2020 deadline in order to enroll in these plans.
FINDING THE BEST ALZHEIMER’S CARE AVAILABLE
If you’ve looked into the question what is Medicare Supplement insurance and researched D, F, and C, you still might find that it doesn’t cover all your needs. In that case, it’s best to also look into long-term care insurance outside of Medicare/Medigap. Unfortunately, Medicare and Medigap simply don’t offer the comprehensive coverage that Alzheimer’s patients typically need, so it can be tough for patients, families, and caregivers to afford care even with government help.
With that said, it’s important to look into your choices, learn more about your Medicare Supplement options and determine if you’re going to enroll in Original Medicare, a Medicare Supplement plan, long-term care insurance, or maybe even all three.
What’s important is that Alzheimer’s patients and their families and caregivers are protected and not worried about the finances. They need to simply focus on the care and ensure that patients are receiving the best coverage possible for the rest of their lives.
If you’re ready to look further into the question, “What is Medicare Supplement insurance?” and research Medicare Supplement plans for Alzheimer’s, use Ensurem’s Medicare Supplement Quote tool.