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Does Medicare cover Alzheimer’s care?
 The most common type of dementia, Alzheimer’s disease is the fifth leading cause of death among U.S. adults aged 65 years or older. In 2020, an estimated 5.8 million Americans 65 years or older were living with Alzheimer’s disease, and that number is projected to rise to nearly 14 million by 2060. Alzheimer’s is progressive by nature and deteriorates a person’s memory, thinking and behavior over time. Eventually, a person may lose their ability to carry out simple tasks. And with Alzheimer’s so common among adults aged 65 and older, a good question to ask is what care and health services does Medicare cover for Alzheimer’s? Before we answer that, it’s important to note that Medicare will cover Alzheimer’s care services for people with early-onset Alzheimer’s as well. How will Medicare cover people with early-onset Alzheimer’s?Medicare 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. Medicare coverage for Alzheimer’sMedicare covers a variety of Alzheimer’s care services, including inpatient treatments and hospital stays, doctor’s visits, testing and care planning services. And while Medicare may cover care services for multiple forms of dementia, this blog will focus only on Alzheimer’s care specifically. Alzheimer’s affects each person differently. Because of this, the type of care and assistance needed may change over time, depending on the stage of the disease they are in. The Alzheimer’s Association defines three general stages of Alzheimer’s:
What does Original Medicare cover for Alzheimer’s?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:
Medicare Part B will cover:
Medicare Part A and Part B may also cover different mental health services including inpatient psychiatric are and outpatient services such as counseling and behavioral health specialist care. Medicare also covers care planning for Alzheimer’s and dementiaCare planning is now provided by Original Medicare for Alzheimer’s patients, as well as Medicare eligible individuals with other forms of dementia. According to the Alzheimer’s Association, 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 physicians, physician assistants, clinical nurse specialists, certified nurse midwives and nurse practitioners. The Alzheimer’s Association list the following as care planning services covered by Medicare:
What Original Medicare will not cover for Alzheimer’sIt’s important to note that Medicare Part A and Part B may not cover everything you need for Alzheimer’s care. Individuals with middle-stage Alzheimer’s and late-stage Alzheimer’s often need more and/or additional care including things like long-term care or an assisted living facility. The following will not be covered by Original Medicare:
Some items may be covered by Original Medicare, but only if you qualify and in a limited capacity. These can include long-term care or an assisted living facility. If you need any of the above health services or items, you may need to explore additional Medicare coverage options. What Medicare coverage options are available for people with Alzheimer’s?While Original Medicare (Part A and Part B) typically cover most Alzheimer’s care services, other coverage options are also available, including Medicare Advantage (Part C) and Medicare Part D prescription drug plans. 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. If your medications are not administered by a healthcare professional or prescribed as part of an inpatient hospital treatment, you’ll need to enroll in Medicare Part D or a Medicare Advantage plan if you would like additional coverage. Medicaid, the Department of Veterans Affairs, and other state programs may also offer additional coverage options for individuals with Alzheimer’s or dementia. Additional resources for Medicare beneficiaries with Alzheimer’sIt is common for those suffering from Alzheimer’s to experience depression, anxiety, and/or frustration, especially as the disease progresses. It’s important that your care or care for a loved one is handled properly. It is also important that if you are a caregiver, that you take care of yourself and have access to all the resources you need. If you need more generalized information and support, the Alzheimer’s Association is a great place to start. You may also have access to community-level or state-level organizations that may be able to help. More articlesMore articlesGet the latestBoost your Medicare know-how with the reliable, up-to-date news and information delivered to your inbox every month. Find a planEnter your ZIP code for plans in your area Meet with usMake an appointment with a licensed insurance agent/producer in your area Can you care for an Alzheimers patient at home?Of the 5.8 million people in the United States who have Alzheimer's disease and other types of dementia, many remain at home, an option that's been shown to help them stay healthier and happier and live longer. But home care isn't always easier — caregiving often falls on the shoulders of family members and friends.
What is the average cost of caring for a person with Alzheimer disease?Median costs for long-term care services 2022
Adult day services: $80 per day. Assisted living facilities: $4,635 per month or $55,620 per year. Private room in a nursing home: $306 per day or $111,657 per year. Semi-private room in a nursing home: $268 per day or $97,747 per year.
What does Medicare cover if you have dementia?Medicare covers inpatient hospital care and some of the doctors' fees and other medical items for people with Alzheimer's or dementia who are age 65 or older. Medicare Part D also covers many prescription drugs. Medicare will pay for up to 100 days of skilled nursing home care under limited circumstances.
Is care for dementia patients free?In most cases, the person with dementia will be expected to pay towards the cost. Social services can also provide a list of care homes that should meet the needs identified during the assessment.
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