Most medical costs to treat Alzheimer’s disease are covered by Medicare, but unfortunately long-term assisted living care costs that most patients eventually need are not. Here’s a breakdown of what Medicare does and doesn’t cover, along with some tips that can help you plan ahead.
For the most part, ongoing medical care to diagnose and treat Alzheimer’s disease is covered by Medicare Part B, including visits to primary care doctors and specialists, lab tests, speech and occupational therapy, home health care and outpatient counseling services. Medicare pays 80% of these costs, and you will be responsible for the remaining 20% after you’ve met your annual Part B deductible.
Inpatient hospital care is also covered under Medicare Part A with a deductible and coinsurance. And, as part of health care reform, Medicare is also covering 100% of annual wellness visits, which includes testing for cognitive impairment.
Most Alzheimer’s medications are covered under Medicare’s Part D prescription drug plans, but plans vary on copayments. If you have a Part D plan, use the Medicare Plan Finder tool at medicare.gov/find-a-plan to compare your plan’s total drug costs against other plans to be sure you’re getting the best coverage. The Alzheimer’s Association offers a chart on coverage for common Alzheimer’s drugs – go to alz.org and type “drug chart” in the search field to find it.
Long-term custodial care
Many seniors are surprised to learn that Medicare does not cover long-term custodial care. This includes nursing home care, the costs of assisted living facilities and adult day care. Medicare does, however, pay for some shorter-term nursing home care, but only up to 100 days following a three-day inpatient hospital stay.
Hiring home help for bathing, toileting and dressing is not covered by Medicare either unless your loved on is also receiving skilled-nursing care or physical or occupational therapy to help with the recovery from an illness or injury.
In the final stages of the disease, Medicare Part A covers nearly all aspects of hospice care, including doctor services, nursing care, drugs, medical equipment and supplies, physical and occupational therapy, homemaker services, counseling and respite care. To qualify, a doctor must certify that a patient has six months or less to live.
If you’re enrolled in a Medicare Advantage plan (like an HMO or PPO), your plan must give you at least the same coverage as original Medicare does, but make sure your doctors are in your insurer’s network to avoid excess costs. Also find out whether you need a referral or prior authorization before getting care.
If you can’t afford your Medicare out-of-pocket costs, or need help with medication expenses, there are government programs that can help. Go to benefitscheckup.org to search.
For more information on assisted living care for dementia and Alzheimer’s patients, contact Spring Arbor.