For the estimated 5.7 million Americans living with Alzheimer’s dementia and their families, early detection and diagnosis is an important first step in health management. Currently less than half of seniors enrolled in Medicare, or their caregivers, are aware that Medicare covers the testing to confirm diagnosis of Alzheimer’s disease.
In fact, many beneficiaries and caregivers are unaware of what Medicare does and doesn’t cover after an Alzheimer’s disease diagnosis. We are going to break the details down for you now, along with some tips that can help you plan ahead.
For the most part, Medicare Part B covers ongoing medical care to diagnose and treat Alzheimer's disease including visits to primary care doctors and specialists, lab tests, speech and occupational therapy, home health and outpatient counseling services. Medicare pays 80% of these costs, while you are responsible for the remaining 20% after you have met your annual Part B deductible, which for 2018 is $183.
Inpatient hospital care is also covered under Part A Medicare with a $1340 deductible and coinsurance. Medicare also covers 100% of annual wellness visits, which includes testing for cognitive impairment.
Most Alzheimer’s medications are covered under Medicare Part D prescription drug plans. Plans do however vary in co-payments.
Long Term Care:
Many seniors and caregivers are surprised when they learn that Medicare does not cover long term custodial care. This includes adult day care, nursing home care and the cost of assisted living facilities. Medicare does pay for some shorter term nursing home care, but only up to 100 days following a 3 day inpatient hospital stay.
Hiring a home health worker to assist with bathing, dressing and using the toilet (also known as custodial care) is not covered by Medicare. To help with these future costs it is wise to consider a long term care insurance policy. Or if your income is low and your assets are limited, you may qualify for Medicaid.
A Medicare Supplemental insurance policy will pay for all or some of the remaining portion of Medicare approved services as well as copayments, coinsurance and deductibles. OR if you enroll in a Medicare Advantage plan (like and HMO or a PPO) your plan must give you at least the same coverage that Original Medicare does, but they are able to offer additional benefits to members. If you enroll in a Medicare Advantage plan you will want to make sure that your doctors are in your insurer’s network to avoid excess costs. You will also need to find out if your insurance company requires a referral or prior authorization before you receive care or have a procedure performed.
In the final stages of Alzheimer’s disease, if Hospice Care is needed, Part A covers nearly all aspects of it. This includes doctor services, nursing care, medications, medical supplies and equipment, physical and occupational therapy, homemaker services, counseling and respite care. In order to qualify a doctor must certify that a patient has 6 months or less to live.
If you need assistance walking through the maze of Medicare with your loved one, give us a call. By utilizing the tools we have available to us we can help you to identify, understand and navigate through the choices that are available to your family member. Our years of experience and training can help save you and your family precious time and energy when it comes to making knowledgeable Medicare decisions.
We have dedicated ourselves and our work to helping seniors, those who are disabled, and caregivers to make informed decisions when it comes to healthcare. Let us help you.