Will Medicare Cover My Alzheimer’s and Dementia?
More than 6 million Americans currently live with Alzheimer’s Disease, with this number projected to rise to nearly 13 million by 2050. One in three senior citizens dies of Alzheimer’s or another cause of dementia, a toll that exceeds that of breast cancer and prostate cancer combined. And in 2021, Alzheimer’s and other dementias cost the nation $355 billion, a cost that could rise to $1.1 trillion by 2050.1
If you’re living with Alzheimer’s or dementia, you may be wondering how Medicare can defray the costs of managing your health condition. We’ll break down the various parts to help you understand what path is best for your individual situation.
Original Medicare and Alzheimer’s Care
Part A (hospital care) covers hospital stays and stints in skilled nursing facilities. Coverage for Alzheimer’s and other dementias often includes:
- Short-term hospitalizations
- Medications and treatments during hospitalization
- Limited home healthcare services
- Short-term skilled nursing facility stays (must be 100 days or less and immediately follow a hospitalization)
- Hospice care
Part A does not cover long-term facility care and all expenses are subject to a deductible ($1,556 in 2022).
Part B (medical care) covers medically necessary and preventative services related to Alzheimer’s. Such outpatient care includes:
- Doctor and specialist visits
- Screening and diagnostic services
- Physical, speech, or occupational therapy
- Services and care related to treatment
- Inpatient and outpatient mental health services
- Durable medical equipment such as canes, crutches, lifts, wheelchairs, and walkers
- Yearly depression screenings
Part B does not typically cover custodial or memory care, which refers to help with daily living activities such as bathing, dressing, and eating. However, there are a few exceptions: if this care is considered medically necessary and is prescribed by a licensed physician or authorized professional, and the services are rendered by a Medicare-approved provider, it will be covered.
Living with multiple chronic conditions?
Alzheimer’s and dementia are both known to have a long list of comorbidities that are associated with the diseases. Some even increase the risk of disease development or worsening. If you’re living with one or more of these chronic conditions, you may qualify for Chronic Care Management under Medicare Part B.
Some examples of comorbidities that may qualify you are diabetes, depression or heart disease. The services covered by this program vary, and not all services related to a condition may be covered.
Medicare Advantage and Alzheimer’s Care
Medicare Advantage, also known as Part C, encompasses all the Alzheimer’s and dementia care that Original Medicare offers. That said, it may also provide extra benefits including vision, dental, and prescription drugs as well as wellness programs. Privately sold by insurers, these plans include networks that limit covered services to selected physicians and providers check to make sure yours are covered before selecting a plan.
Other benefits that may be offered include:
- In-home care in addition to the 35 hours weekly offered by Original Medicare
- Meal deliveries
- Gym memberships
- Alternative and complementary therapies such as acupuncture
- A cap on out-of-pocket expenses (which can provide cost savings)
Medicare Advantage Plans are not a “one-size-fits-all” type of health care plan. There are many variations, designed with different goals in mind. Chronic Condition Special Needs Plans (C-SNPs) for example, are designed to serve those living with chronic conditions such as Alzheimer’s and dementia.
All Special Needs Plans (SNPs) offer access to a specialist network; you’ll typically need a referral to access these doctors, but services such as in-network pap test and pelvic exams as well as yearly screening mammograms do not require them. While some SNPs allow members out-of-network access, others do not.
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SNPs offer benefits and services not found in other types of Medicare Advantage Plans. One of the most notable benefits of a C-SNP is the use of care coordinators. These care coordinators help you stay on track with your care. For example, a care coordinator can help schedule appointments, get the right prescription drugs and monitor other health-related activities.
Prescription Drug Coverage for Alzheimer’s through Part D
Part D (prescription drug coverage) is an add-on to Original Medicare, which itself does not cover medications. A few things to consider when choosing a plan to manage your Alzheimer’s2:
- Are your Alzheimer’s drugs on the formulary?
- Does the plan cover your correct medication doses?
- Will your medication coverage be limited by plan rules or policies?
- What will the plan cost?
- Is your local pharmacy in-network?
Among other medications, Part D covers two FDA-approved prescription medications that treat cognitive elements of Alzheimer’s: cholinesterase inhibitors and memantine. Cholinesterase inhibitors increase brain neurotransmitters, thus slowing down cognitive decline, while memantine is prescribed in combination to further slow the decline.
Medicare Supplement Insurance and Alzheimer’s Care
Also known as Medigap, Medicare Supplement Insurance plans can help cover the gap between your Original Medicare coverage and out-of-pocket costs. This can include:
- Other medical costs
You can apply Medigap to out-of-pocket costs for services such as:
- Physician visits
- Hospice care
- Part-time skilled nursing care
- Diagnostic testing
Nine out of the 10 standard Medigap plans offer coverage for all or some of the Part A deductible.
What are Alzheimer’s Disease and Dementia?
Alzheimer’s accounts for between 60% and 80% of dementia cases. Dementia is a general means of describing loss of memory and cognitive abilities that contribute to daily life. Most people living with Alzheimer’s are 65 years or older.
Since Alzheimer’s is a progressive disease, it will worsen over time. According to the Alzheimer’s Association3, the disease is the sixth leading cause of U.S. deaths. While there is no cure, there are medical interventions that can help prolong life as much as 20 years post-diagnosis.
What are the Risk Factors for Alzheimer’s?
Risk factors for Alzheimer’s include:
- Advanced age
- Family history
- Head injury
- Poor heart health, including conditions such as heart disease, diabetes, high cholesterol, stroke, and high blood pressure
Those with Down Syndrome have also been found to be at higher risk for developing the disease.
No current research indicates a cure for Alzheimer’s. That said, there are medical procedures, treatments and drug regimens that can help prolong your quality of life – many of which are covered by Medicare while some require a Medicare health or supplemental plan to cover the cost. Ensuring you have the right selection of coverage can help protect you from unnecessarily large medical bills, so you can get the care you need.
If you’re unsure which Medicare solutions are right for you or your loved one, we can help. To learn more, call a licensed Ensurem agent at the number on this page.
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Ensurem, LLC., is a licensed and certified representative of Medicare Advantage HMO, PPO and PPFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Ensurem and the plans we represent and their subsidiaries follow federal civil rights law and do not discriminate or exclude people because of their race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. These plans have eligibility requirements, exclusions and limitations. For costs and complete details (including outlines of coverage), call a licensed insurance agent at the toll-free number shown. Medicare Supplement Insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease.
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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