Alzheimer`s disease if the fifth leading cause of death among U.S. population older than 65 years. Estimated number of people living with Alzheimer`s disease is around 6 milion, and rising. Alzheimer’s is progressive neurodegenerative disease which deteriorates a person’s memory, thinking and behavior over time. Eventually, a person may lose their ability to carry out simple tasks. Typical life expectancy after Alzheimer`s is diagnosed is from 3 to 9 years. There is no “one” cure for Alzheimer`s disease.
The Alzheimer’s Association defines three general stages of Alzheimer’s:
- Early-stage Alzheimer’s (mild)
- Middle-stage Alzheimer’s (moderate)
- Late-stage Alzheimer’s (severe)
In this blog we will breakdown how Alzheimer`s care services are covered under Medicare. It is important to state that Medicare will also cover Alzheimer`s care services for people with early-onset Alzheimer`s (often people younger than 65) as well.
MEDICARE COVERAGE FOR ALZHEIMER`S
Medicare covers a variety of Alzheimer’s care services, including inpatient treatments and hospital stays, doctor’s visits, testing and care planning services. Alzheimer’s affects each person differently. Because of that, the type of care and assistance needed may change over time, depending on the stage of the disease they are in.
Medicare also may provide coverage for early-onset Alzheimer’s – for individuals with Alzheimer’s who are under age 65. Many times, early-onset Alzheimer’s shows up when someone is in their 40s or 50s. If you or someone you care for has been diagnosed with early-onset Alzheimer’s, they will qualify for Medicare after receiving disability benefits for 24 months.
Original Medicare – Part A and Part B will typically cover the diagnosis, evaluation, treatment, and care planning for Alzheimer’s at every stage.
Medicare Part A will cover:
- Inpatient hospital care, skilled nursing facility care and psychiatric care
- Home health care
- Hospice care
- Inpatient medications (drugs you may get during inpatient hospital stay)
Medicare Part B will cover:
- Outpatient hospital services
- Doctor`s visit
- Physical, occupational and speech therapy
- Annual wellness visits and health risk assessments
- Diagnostic radiology testing (MRI or CT scan or EEG)
- PET scan (test that can diagnose Alzheimer`s disease at early stage)
- Medications administered by doctor
Medicare Advantage (Part C) will cover every service that is covered by Original Medicare. It may have some other additional benefits, but that depends on which insurance carrier you are buying plan from.
If your medications are not administered by a healthcare professional or prescribed as part of an inpatient hospital treatment, you will need to enroll in Medicare Part D or a Medicare Advantage plan if you would like additional coverage for needed medications.
Medicare Special Needs Plans (SNPs) – a special kind of Medicare Advantage plan – are uniquely available to individuals with Alzheimer’s and other forms of dementia. These Special Needs Plans are uniquely designed for individuals with Alzheimer’s or dementia.
In the worst case of late-stage of Alzheimer`s disease, when individuals are determined to have less than six months to live, Medicare provides an all-inclusive hospice benefit. Very late-stage Alzheimer’s patients will qualify for this program which includes all palliative care that the patient needs, as well as counseling for the individual and their family.
CARE PLANNING COVERAGE
Care planning allows individuals with Alzheimer’s and their caregivers to discover medical and non-medical treatments available, clinical trials they may participate in, as well as community services and resources to help contribute to improved quality of life. Care planning is provided by Original Medicare for Alzheimer’s patients, as well as Medicare eligible individuals with other forms of dementia. Care planning providers are physicians, physicians assistants, clinical nurse specialist, certified nurse midwives and nurse practitioners.
The Alzhemier`s Association lists services that are included in care planning:
- evaluating cognition and function
- measuring neuropsychiatric sypmtoms
- medication reconciliation
- safety evaluation (including driving ability)
- identifying caregivers and caregivers needs
- identifying and assessing care directives
- planning for palliative care needs
- referrals to community services for both the beneficiary and their caregiver
WHAT ALZHEIMER`S CARE SERVICES MEDICARE WON`T COVER?
Even though Medicare will cover wide range of services connected to Alzheimer`s disease, there is much that is not covered. With more progressive stage of Alzheimer`s, individuals often have bigger need for additional care, like long-term care or stay in assisted living facility. This services may be provided through Original Medicare, but only if you qualify and it is provided for a limited time on limited capacity. In certain cases, this services in excluded from coverage, so it is important to know what is covered under Medicare and what is not, because costs of not covered treatments can easily hit high amounts on monthly or yearly basis.
Next listed services needed for treating middle-stage or late-stage of Alzheimer`s are not covered under Medicare:
- Personal aid assistance (with exception, if it is provided as a home health care under Part A)
- Respite care (with exception, if it is provided as hospice care under Part A)
- Adult day care
- Custodial care in nursing facility
- Over-the-counter vitamins and supplements
- Incontinence supplies