Alzheimer’s and Medicare: What is Covered and What Is Not

According to the Alzheimer’s Association, one in three seniors will die from Alzheimer’s disease or another dementia. In this article, we will review:

  • What areas parts B and D of Medicare will cover in relation to Alzheimer’s.
  • How Medicare Supplemental Insurance can help with care and treatment for this disease.
  • Why it’s wise to consult with an independent agent from Senior Financial Group to examine long-term care insurance before receiving a disqualifying diagnosis.

There are seven stages of the disease, with early stages marked by symptoms that generally don’t require care but do initiate the process of finding a diagnosis. During this time, an individual might struggle to find the right word, ask the same question repeatedly, become forgetful or experience mood swings.  This initial doctor’s visit will most likely be the first of many.

Because an “Alzheimer’s test” doesn’t exist, doctors begin eliminating other potential diseases that could be causing these symptoms, requiring possible collaboration with neurologists, psychiatrists, psychologists, as well as ordering various brain scans. It can quickly become a pricey process, but it’s also a diagnostic one, so Medicare Part B is applied.

  • Part B of original Medicare will pay 80% of the bill after the patient has met the Part B annual deductible.
  • If the patient has purchased Medicare Supplemental Insurance – something worth having during the early stages of this disease – it will handle the remaining 20%.

If that diagnostic process ends with a determination that it is Alzheimer’s, the treatments vary. Most patients immediately start taking medications that can help slow the progress of the disease. Medicare Part D will help cover the cost of the drug so long as it is on its approved drug list, as many common Alzheimer’s drugs are.

Other treatments can include various forms of therapy—physical, occupational or sessions with a mental health care professional.  Provided these services are considered “medically necessary” and prescribed by a doctor, Medicare Part B will again cover 80% of these costs. And again, if you have a Medicare Supplement – also referred to as a Medigap policy – it will pick up the 20% not covered by Medicare Part B.

As the disease enters the late stages, a patient might experience extreme confusion, become delusional, begin wandering, and incontinence can set in.  This is the point where residential 24-hour care will most likely be required. Medicare does not offer long-term care to help pay for residential care.  Medicare coverage will only apply in “limited circumstances”—for example, if a patient is hospitalized for at least three days and then needs nursing home care, Medicare will cover skilled nursing home care for up to 100 days.

The reality is that 100 days may prove to be a fraction of the amount of nursing or in-home health care that an Alzheimer’s patient may require. Once a person needs help with Activities of Daily Living – referred to as ADL’s including but not limited to dressing, personal hygiene, eating, basic mobility – Medicare considers this “custodial care”, meaning it’s non-medical. As such, it is not considered medically necessary and therefore Medicare does not cover the bill.

The average Alzheimer’s patient lives four to eight years after diagnosis. It is this period of long-term residential care that can be financially devastating, costing thousands of dollars a month.   A long-term care policy must be purchased outside of Medicare and before someone is diagnosed with Alzheimer’s. Once diagnosed, they cannot apply for long-term care insurance.

It’s wise to consult with an independent agent from Senior Financial Group and begin looking into long-term care insurance when you’re in your 50’s or early 60’s, before premiums skyrocket or your health begins to worsen and the policies available to you narrow.   Click here to request your free consultation with a Senior Financial Group advisor.

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