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Medicare and Alzheimer’s Disease

Medicare and Medicare Supplement insurance (also called Medigap) do provide medical coverage and help with health care costs for treating Alzheimer’s disease. However, you may still face large out-of-pocket costs for certain treatments or use of long-term care facilities.

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How Many People Have Alzheimer’s?

The Alzheimer’s Association estimates that 5.8 million Americans are living with Alzheimer’s disease in 2019.1

It is the most common form of dementia and mainly affects those 65 and older. The number of people affected by the disease is expected to rise to 13.8 million people by 2050.1

Medicare and Medigap Coverage for Alzheimer’s Disease

Original Medicare (Part A and Part B) provides coverage for various Alzheimer’s-related treatments, such as:

  • Diagnostic testing
  • Doctor services
  • Hospice care
  • Part-time skilled nursing care

Medigap can provide coverage for some of the out-of-pocket costs that come with those treatments.

If you develop Alzheimer’s before you turn 65 years old, you might qualify for Medicare coverage early.

If the Alzheimer’s diagnosis is so severe that you cannot work, you may qualify for Social Security Disability Insurance (SSDI) benefits. If you receive SSDI benefits for 24 months due to Alzheimer’s Disease, you will be eligible for Medicare.

Medicare Part A Covers Hospital Costs for Alzheimer’s Care

Medicare Part A provides coverage for hospital services such as:

  • Inpatient hospital care
  • Hospice care
  • At-home part-time skilled nursing care
  • At-home physical therapy.

Two services covered by Medicare Part A that people with Alzheimer’s may need are skilled nursing facility care (SNF) and hospice care.

Part A will only cover your SNF care if you were hospitalized for 3 days and require daily care for the same condition for which you were hospitalized.

Part A also will cover hospice care, but only if your Alzheimer’s condition is terminal.

Medicare typically does not cover custodial care (non-medical assistance with routine daily activities, like bathing, eating and getting dressed) — at home or in a nursing home — if that’s the only care you need.

Part A Out-of-Pocket Costs and Medigap

There are many out-of-pocket costs associated with Medicare Part A.

Before Medicare Part A pays benefits for your hospital inpatient care, you need to meet a $1,364 deductible per benefit period in 2019.

There are also co-insurance and co-payment costs that come with Part A hospital care, hospice care and skilled nursing care.

If you have a Medigap policy, it may cover some of these costs. All Medigap plans provide some coverage for the hospital and hospice care out-of-pocket costs.

In addition, most Medigap plan options provide at least some coverage for the Part A deductible and skilled nursing care co-insurance.

Part B Covers Medical Services and Devices Related to Alzheimer’s Disease

Medicare Part B provides coverage for medical services such as:

  • Doctor services
  • Diagnostic tests and screenings
  • Durable medical equipment
  • Ambulance services

Two services covered by Medicare Part B that people with Alzheimer’s may need are therapeutic services and psychological or disease-management counseling.

Medicare Part B also may cover some of the necessary Alzheimer’s diagnostic tests.

For example, if your doctor recommends a diagnostic test to treat Alzheimer’s, such as a CT scan or an MRI, Medicare Part B may help cover the cost.

Early detection allows families to find a caregiver, make end-of-life choices, and get their financial health in order.

Part B Out-of-Pocket Costs and Medigap

If you use Medicare Part B to cover your Alzheimer’s treatments, it comes with an annual deductible and a 20% copayment for covered services.

You must pay the $185 a year Part B deductible in 2019 before Part B coverage kicks in, and then Medicare Part B pays for only 80% of the Medicare-approved amount for covered services. You are responsible for the remaining 20%.

Medicare Supplement insurance can help you cover some of these costs.

All standardized Medigap plan options provide at least some coverage for the Part B copayment. Two of the plan options (Plan C and Plan F) also provide coverage for the Part B deductible.

You can use the comparison chart below to see the benefits offered by each of the standardized Medigap plans in 2019.

Medicare Supplement Benefits A B C D F1 G K2 L3 M N4
Part A co-insurance and hospital costs
Part B co-insurance or co-payment 50% 75%
First 3 pints of blood 50% 75%
Part A hospice care co-insurance or co-payment 50% 75%
Co-insurance for skilled nursing facility     50% 75%
Medicare Part A deductible   50% 75% 50%
MedicarePart B deductible              
Medicare Part B excess charges              
Foreign travel emergency     80% 80% 80% 80%     80% 80%
1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything.
2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

Medicare does not cover all Alzheimer’s treatments

Unfortunately, there are some important Alzheimer’s treatments that Medicare does not fully cover or does not cover at all.

Original Medicare does not cover long-term care, prescription drug coverage, caregiving support and certain other services that may be needed for Alzheimer’s patients. As a result, people with Alzheimer’s may have high out-of-pocket costs.

Medicare and long-term care costs

One of the largest misconceptions about Medicare is that it covers long-term care. Original Medicare and Medigap do not cover long-term care.

Long-term care helps with personal care such as bathing, dressing, eating and using the bathroom. It is a common management treatment used for those with Alzheimer’s.

You will likely pay out-of-pocket for this care, unless you have long-term care insurance, or qualify for Medicaid. 

Some Medicare Advantage Plans May Help Cover Alzheimer’s Care

Medicare Advantage (Medicare Part C) plans are sold by private insurance companies and replace Medicare Part A and Part B.

Medicare Advantage plans offer all of the same benefits that Original Medicare offers, and some plans may offer additional benefits such as:

  • Prescription drug coverage
  • Routine dental and vision coverage
  • Hearing coverage and allowances for things like hearing aids

Some Medicare Advantage plans may also offer additional benefits that can help with dementia care, such as home modifications, adult day care and non-medical care at home, all of which are not typically covered by Original Medicare.

Plan benefits may vary and may not be available in all locations.

Does Medicare Cover Caregiver Support?

Some Medicare Advantage plans may cover caregiver support, which can be helpful for a beneficiary who has Alzheimer’s disease.

Depending on the plan, some of these benefits may include services like:

  • Meal preparation assistance
  • Transportation
  • Taking vital signs
  • Medication management

Original Medicare (Part A and Part B) does not provide coverage or payment for most caregiver services. If you need assistance from a caregiver, such as a spouse or family member, they are not financially compensated by Medicare.

Medicare Part A provides short-term respite care so your caregiver can rest, but this is only if you are approved for inpatient hospice care, and it lasts only up to 5 days. To qualify for hospice care, you must be terminally ill with less than 6 months to live.

Caregivers are a necessary part of an Alzheimer’s patient’s care. The daily requirements vary depending on the stage of the patient.

For example, in early-stage Alzheimer’s, you may only need companionship, help with minor memory problems, and general support. In late-stage Alzheimer’s, the need for intensive caregiving is required to provide full-time personal care, medical assistance, communication, and transportation.

Does Medicare Cover Prescription Drugs for Alzheimer’s?

There are no medical cures for Alzheimer’s, but there are prescription drugs that can help stabilize or reduce Alzheimer’s symptoms, such as memory loss or confusion.

Original Medicare does not provide prescription drug coverage. However, you can get coverage from a Medicare Part D prescription drug plan or from a Medicare Advantage plan that offers prescription drug coverage.

According to the Alzheimer’s Association, there are two types of medication that are approved for Alzheimer’s treatment.

Cholinesterase inhibitors (e.g.: Aricept, Exelon, Razadyne) and memantine (e.g.: Namenda) help treat cognitive issues such as memory loss, thinking problems, and confusion.

A Medicare Part D prescription drug plan can provide coverage that helps pay for important medications. You should review your plan’s formulary and see if your prescriptions are covered before enrolling.

What Is Alzheimer’s Disease?

Alzheimer’s disease is a type of dementia that results in loss of memory, loss of thinking and language skills, and behavioral changes. It is a progressive and irreversible brain disease that attacks the brain’s nerve cells.

Minor Alzheimer’s symptoms may include:

  • Mild memory loss
  • Difficulty understanding visual images
  • Mood or personality changes
  • Withdrawing from work or social activities

Major Alzheimer’s symptoms include:

  • Disorientation
  • Mood and behavior changes
  • Unfounded suspicions about friends and family members
  • Difficulty speaking, swallowing and walking

Alzheimer’s disease on its own is not fatal, but it does directly cause many complications that can result in fatal conditions such as pneumonia, infections, and an overall loss of bodily function.

3 Stages of Alzheimer’s Disease

There are three stages of Alzheimer’s disease. The rate at which the disease progresses varies depending on the individual, as do the symptoms.

  • Mild Alzheimer’s (Early stage)
    In the first stage of Alzheimer’s disease, an individual will show few outward symptoms. However, a PET scan can reveal whether or not someone is in the early stages of Alzheimer’s.

    Other difficulties during the early stage of Alzheimer’s may include trouble remembering names, misplacing valuable items and trouble organizing and planning.

  • Moderate Alzheimer’s (middle stage)
    The middle stage of Alzheimer’s disease is the longest stage, lasting several years in many cases. Damage to the brain’s nerve cells can make it difficult to perform simple tasks and express thoughts.

    Someone in the middle stage of Alzheimer’s disease may also begin acting differently and become angry or frustrated.

  • Severe Alzheimer’s (late stage)
    Individuals with severe Alzheimer’s disease may experience severe mood swings, anxiety, suspiciousness of others, social withdrawal and/or depression. They may also have more difficulty communicating and lose their ability to walk.

    During this stage of Alzheimer’s, individuals may require constant assistance.

Medicare Supplement Plans Can Help Cover Your Medicare Out-of-Pocket Costs

Call to speak with a licensed insurance agent today who can help you find Medigap plans in your area that can help cover some of the out-of-pocket Medicare costs you may face with certain Alzheimer’s treatments.

 

Compare Medigap plan costs in your area.

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Or call --ms-tfn-- to speak with a licensed insurance agent.

 

1 2019 Alzheimer’s Disease Facts and Figures. (2019). Alzheimer’s Association. Retrieved from www.alz.org/media/Documents/alzheimers-facts-and-figures-2019-r.pdf.

2 Alheimer’s Association. Medications for Memory. Retrieved Aug. 2019, from www.alz.org/alzheimers-dementia/treatments/medications-for-memory.

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