Does Medicare Cover Dementia and Alzheimer’s Care?

If a loved one has been diagnosed with dementia or Alzheimer’s, understanding your healthcare coverage is one of the challenges you’ll have to face. One common question that comes up is, “Does Medicare cover dementia and Alzheimer’s care?” The answer is quite tricky. Medicare coverage options come in four parts that you first need to understand.

Medicare is a federal health insurance program for individuals 65 and older or those with certain disabilities, providing assistance to increase their access to care. Delve into Medicare coverage options for dementia and Alzheimer’s Care services so you can make informed decisions about your loved one’s care.

What is Medicare?

Medicare is a government-sponsored health insurance program for people 65 and older or younger individuals with certain qualifying disabilities. Medicare is a four-part system, offering a range of coverage options for eligible individuals. Here’s a breakdown of each part:

• Part A (Hospital Insurance): This is your safety net for major medical expenses. Part A covers skilled nursing facility care, hospice, inpatient hospital stays, and certain home healthcare services. Think of it as a support for big-ticket medical needs.
• Part B (Medical Insurance): This part acts like your personal healthcare umbrella, offering coverage for a broader range of medical encounters. Part B covers outpatient care like doctor visits, diagnostic tests, preventive services, and some medical equipment. It’s designed to help manage your ongoing healthcare needs.
• Part C (Medicare Advantage Plans): If you’re looking for an alternative way to receive your Medicare benefits, Part C might be a good option. Medicare Advantage Plans are private insurance programs approved by Medicare that offer a bundled approach to coverage. Typically, they cover everything that Part A and Part B and often include supplementary benefits like dental, vision or even limited long-term care services. It’s important to remember that these plans come with their own set of rules, networks, and costs, so careful research is necessary before enrolling.
• Part D (Prescription Drug Coverage): As the name suggests, Part D is a separate insurance plan that helps pay for medications. It comes with various plans, each with its own formulary or list of covered drugs, copays, and deductibles. It’s important to compare plans to find one that covers the medications you need at an affordable price.

When referring to Original Medicare coverage options, we’re talking about Parts A and B, the traditional fee-for-service program. Medicare Advantage Plans (Part C) are private alternatives that offer a different way to access your Medicare benefits. Explore what Medicare covers for dementia and Alzheimer’s care.

What Does Medicare Cover For Dementia And Alzheimer’s Care?

Here’s what Medicare can help with for dementia and Alzheimer’s:

Diagnosis and Treatment

Part B can help pay for doctor visits . It includes seeing specialists, getting memory tests, and brain scans if needed. Early diagnosis is important, and Medicare can lend a hand with these initial steps.

Hospital Stays

If you need to be hospitalized because of complications from dementia or Alzheimer’s, Part A can be a big help as it covers inpatient stays. The hospital expense is one less thing to worry about.

Skilled Nursing Facility Care

Part A will cover short stays of up to 100 days in a skilled nursing facility and only if a doctor says the care is medically necessary. Nurses and therapists will help you get better, on top of receiving daily assistance.

Home Health Care

For people who can be safely cared for at home, Part A helps cover some skilled home health services, like physical therapy or help with wound care. To be eligible, it must be recommended by a doctor as a necessity.

Medications

The Part D of Medicare covers dementia and Alzheimer's care drugs and may help pay for some medications to manage symptoms. These drugs are classified as anti-dementia drugs or cognitive enhancers. However, coverage will depend on your individual plan. Plus, you may need to get a prior authorization from your provider before they can cover for the drugs.

What Medicare Does Not Cover

It’s important to be aware of what Medicare can’t pay for so you can manage your finances. Unfortunately, Medicare coverage doesn’t extend to long-term care needs like assisted living or nursing homes. It can help fund short-term stays in skilled nursing facilities, but not the 24-hour care or lodging in assisted living units or nursing homes.

Planning for Long-Term Care Needs

Since Medicare doesn’t cover long-term care, what are your options for financing? Here are some choices.

• Medicaid: Medicaid can be one of your funding sources. It can help pay for some assisted living expenses. However, eligibility requirements and benefits vary significantly by state. Generally, Medicaid may cover nursing home care or in-home care services, but qualifying often requires meeting specific income and asset limitations.
• Long-Term Care Insurance: This type of insurance is designed specifically to help pay for assisted living, home care services, adult day care and other care needs. Premiums can be substantial, and it’s essential to consider purchasing coverage when you’re healthy, as pre-existing conditions may affect your eligibility or rates.

The Importance of Planning Ahead

Dementia and Alzheimer’s are progressive diseases, so it’s wise to plan for the future. Understanding the extent of Medicare coverage and other insurance plans can help reduce the financial strain of long-term care on your family. Here are other reasons why planning in advance is a must.

Cost of Care

Long-term care can be hefty. Nursing homes and in-home care services will burn your hard-earned money. Explore options like long-term care insurance and discuss financial plans with your loved ones.

Caregiver Support

Caring for someone with dementia or Alzheimer’s can be physically, mentally, and emotionally demanding. Advance planning can solidify your access to the support and resources needed, such as respite care or support groups.

Legal and Financial Considerations

You’ll have to eventually make difficult decisions. Securing your legal documents now, like a power of attorney and a living will, can ensure your wishes regarding medical care and financial matters are honored. Talk to an elder law attorney to get advice.

Explore Your Medicare Coverage Options

Medicare can help fund some of your care needs but it doesn’t cover long-term custodial care, like assisted living. Understanding its different parts is a crucial first step in determining where you likely financially fall short in case you’ll need the benefits.

Many older people living with Alzheimer’s and dementia don’t receive adequate care because they fail to plan for their care needs or don’t understand their coverage. If you need guidance, connect with one of our dementia care professionals at Senex Memory Advisors. We can guide you in navigating the financing options for long-term care. Get in touch with us.