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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.
The Alzheimer’s Association estimates that 6 million Americans were living with Alzheimer’s disease in 2021.1
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
Original Medicare (Part A and Part B) provides coverage for various Alzheimer’s-related treatments, such as:
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.
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Medicare Part A provides coverage for hospital services such as:
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.
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 $1,600 deductible per benefit period in 2023.
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.
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Medicare Part B provides coverage for medical services such as:
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.
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 $266 a year Part B deductible in 2023 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.
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.
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.
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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:
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.
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:
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.
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.
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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:
Major Alzheimer's symptoms include:
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.
There are three stages of Alzheimer's disease. The rate at which the disease progresses varies depending on the individual, as do the symptoms.
Learn more about common procedures that medicare covers.
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.
Or call 1-800-995-4219 to speak with a licensed insurance agent.
1 2021 Alzheimer's Disease Facts and Figures. (2021). 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.
Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareSupplement.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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