Does Medicare Cover Alzheimer’s Disease Care?
Alzheimer’s disease is a progressive cognitive impairment that affects memory and motor skills. Medicare covers several services related to Alzheimer’s disease, such as diagnosis and home health care, but it will not cover long-term care in a nursing home or assisted living facility.
Gaps in Medicare Coverage for Alzheimer's Disease Care
In 2020, an estimated 5.8 million Americans ages 65 and older were living with Alzheimer’s dementia, according to the Alzheimer’s Association.
Alzheimer’s disease is a progressive brain disease that affects memory and cognitive function. There is no cure.
Most people with Alzheimer’s disease have Medicare, but the program lacks coverage for several services patients often need as the disease progresses.
- Extended nursing home stays
- Assisted living facilities
- Adult day care
- Custodial care (assistance with activities of daily living, such as bathing, eating and dressing)
Many patients use Medicaid to fill coverage gaps, including nursing home care.
According to a 2015 Kaiser Family Foundation analysis, about a quarter of adults with dementia are covered by Medicaid over the course of a year.
Patients must have low incomes and limited assets to qualify for Medicaid.
Some people may qualify for both Medicare and Medicaid. This is known as dual eligibility.
A Dual Eligible Special Needs Plan, or D-SNP, is a specific type of Medicare Advantage plan that includes at least the same coverage as Original Medicare (Part A and Part B) as well as Part D prescription drug coverage. But D-SNPs usually offer additional benefits, such as dental, vision, nursing home care, personal care, and home- and community-based services.
Early-Stage Alzheimer's Disease Medicare Coverage
During the early stage of Alzheimer’s disease, a person may still be able to function independently, despite progressive memory lapses.
For people with early-stage Alzheimer’s disease, coming up with the right word or name becomes difficult. They may also misplace everyday objects or struggle to perform tasks at work.
- Diagnostic Testing
- Medicare beneficiaries can receive a yearly wellness visit with no out-of-pocket charge. This visit includes an evaluation for cognitive impairments like dementia. Medicare also covers 80 percent of additional diagnostic tests, such as MRIs and CAT scans.
- Mental Health Services
- Medicare pays some mental health care costs, including family counseling, visits to a psychiatrist and psychiatric evaluations. You will pay 20 percent of the Medicare-approved amount for these services, and the $203 Medicare Part B deductible applies. You will pay nothing for a yearly depression screening.
- Prescription Drugs
- Medications may be prescribed to help slow the spread of the disease. Medicare Part D and Medicare Advantage plans with prescription drug coverage can help pay some costs associated with these medications. Deductibles, coinsurance and copayments apply and will vary by plan.
Middle-Stage Alzheimer's Disease Medicare Coverage
Middle-stage Alzheimer’s is usually the longest stage. It may last several years.
Symptoms vary from person to person but often include significant changes in personality, becoming lost, deepening confusion and experiencing even greater memory loss.
This is usually the stage when patients require more assistance with daily tasks such as self-care and grooming.
- Home Health Services
- Medicare covers home health care services such as part-time skilled nursing care, physical therapy, speech-language pathology and more. The home health agency must be Medicare-certified, and a doctor must certify that you are homebound. There are no deductibles or coinsurance for these services. Original Medicare does not cover 24-hour home care, homemaker services or personal care.
- Durable Medical Equipment
- As you age, durable medical equipment, or DME, is often necessary to make your home safer and more accessible. This can include hospital beds, wheelchairs, walkers, canes, commode chairs and more. You doctor must prescribe DME for you. Medicare Part B users typically pay 20 percent of the approved cost for this equipment, and the Part B deductible applies. You may be required to either rent or buy your equipment.
Beginning in 2019, the Centers for Medicare & Medicaid Services (CMS) allowed Medicare Advantage plans to begin offering non-skilled, in-home care services.
In 2021, about 730 plans are expected to provide these additional supplemental benefits, which can include adult day care services, meal delivery, in-home supportive services and support for caregivers, according to CMS.
Late-Stage Alzheimer's Disease Medicare Coverage
During late-stage Alzheimer’s, patients require extensive care and around-the-clock assistance.
They experience changes in physical abilities, such as walking and sitting, and lose the capacity to respond to their environment.
Hospice care is often required in the final stage of Alzheimer’s disease before death.
Death is often caused by pneumonia, dehydration, malnutrition, falls or infections.
- Hospital Stays
- Medicare Part A will cover up to 60 days of hospitalization per benefit period. If you’re in the hospital for 60 to 90 days, Medicare will pay some costs but not all. The $1,484 Part A deductible applies.
- Short-Term Stay in a Skilled Nursing Facility
- After being admitted to the hospital, patients may need to spend additional time at a skilled nursing facility to recover from an illness or injury. Medicare will fully cover your first 20 days in a skilled nursing facility and the cost is $176 per day for days 21 through 100. Your doctor must certify that you need this care.
- At the end of life, hospice services are often required. All hospice-related services are covered under Medicare Part A. This includes nursing care, hospice aide and homemaker services, grief counseling for your family and short-term respite care if a family member or caregiver needs a break. Hospice care is intended for people with a life expectancy of six months or less. If you live longer, Medicare will continue to cover the cost of your hospice care, but you will need a medical director or other hospice doctor to recertify you.
Medicare does not cover long-term care. This includes extended stays at nursing homes or assisted living facilities.
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