Does Medicare Cover Alzheimer's Care?
- Does Medicare cover Alzheimer's care? Learn what is and isn't covered under Medicare and how to find vital resources in this guide for seniors and their loved ones.
Because Alzheimer’s disease typically affects adults aged 65 or over, many individuals who’ve been diagnosed with this type of dementia receive their health benefits through Medicare. If you or a family member have recently been diagnosed with a dementia-related illness, you may be faced with the question, "Does Medicare cover Alzheimer’s care?" Thankfully, this federal health care plan covers many of the costs associated with Alzheimer’s disease. In this article, you'll learn what coverage Medicare provides for Alzheimer’s care and related expenses and how to find additional resources.
What Is Alzheimer’s Disease?
Alzheimer’s disease is a progressive form of dementia that affects an individual’s cognitive abilities. When it occurs in an individual younger than 65, it’s known as early onset Alzheimer’s.
Symptoms of Alzheimer’s may include:
- Memory loss
- Impaired reasoning
- Unpredictable behavior
- Language difficulties.
- Visual or spatial impairment
Does Medicare Cover Alzheimer’s Care?
Yes. The diagnosis and care of individuals with Alzheimer’s are covered under Medicare. Here’s a breakdown of coverage by Medicare plan type:
Medicare Part A
Part A is Medicare’s hospitalization component, which provides coverage for care received during inpatient stays. Part A benefits include:
- Inpatient hospital stays
- Medications and treatments received during inpatient stays
- Short-term residential care in a nursing home or skilled nursing facility
- Home health care
- Hospice services
Medicare Part B
Medicare Part B covers services related to outpatient care. Part B benefits include:
- Physician visits (including specialists)
- Diagnostic testing and screenings
- Clinical research
- Medically necessary durable medical equipment
- Prescription drugs administered by a clinician in an outpatient setting
- Outpatient treatments
- PT, OT and speech therapies
Medicare Part C
Also referred to as Medicare Advantage, Part C offers seniors an alternative to Original Medicare. Because Part C plans are administered through private insurance companies, they may offer varying coverage options. However, under federal law, all Advantage plans must offer, at minimum, the same benefits provided by traditional Part A and B policies, so seniors with Alzheimer’s receive the same, or more, coverage as those with Original Medicare. Part C policies often bundle in prescription drug coverage, eliminating the need for a separate plan.
Medicare Part D
Part D is Medicare’s prescription drug coverage. FDA-approved medications to treat Alzheimer’s are typically reimbursable under Part D. However, Part D plans vary, and beneficiaries should check their plan’s formulary to see which medications are covered under their policy.
Can Medicare Supplement Insurance Help With Expenses Associated With Alzheimer’s Disease?
Medicare supplement insurance, or Medigap, is private insurance that’s designed to cover out-of-pocket expenses remaining after Medicare reimbursement. Although these plans don’t provide additional health insurance coverage for seniors, they can defray costs associated with Alzheimer’s care, including:
Medigap policies vary by plan type and may offer different benefits, coverage amounts and deductibles.
What Alzheimer’s-Related Services and Supplies Does Medicare Cover?
Whether you have Original Medicare or a Medicare Advantage plan, your policy should cover preventative, diagnostic and treatment services related to Alzheimer’s Disease. Reimbursable medical services and supplies typically include the following.
Appointments with a primary care physician, geriatrician or neurologist to diagnose, manage and monitor Alzheimer’s are covered under Medicare Part B. Appointments may include yearly wellness visits, which can include cognitive screenings and other assessments in addition to a routine physical.
Diagnostic tests and screenings can be used to detect early signs of dementia, rule out other medical reasons for cognitive decline and monitor the progression of the disease. Covered tests may include:
- Brain imaging using MRI or CT
- Cognitive impairment assessments
- Neurological evaluation
- Yearly depression screenings
- Bloodwork and other laboratory tests
Occupational, physical and speech therapies are covered under Medicare Part B if they’re deemed medically necessary to improve or mitigate symptoms associated with Alzheimer’s.
Two types of prescription medications — memantine and cholinesterase inhibitors — are currently authorized by the FDA for treating cognitive symptoms associated with Alzheimer’s. They’re covered by Medicare as long as they’re included on your plan’s formulary.
Durable Medical Equipment
Seniors who require assistive devices to help with Alzheimer’s-related mobility issues can get reimbursed for durable medical equipment, as long as it's deemed medically necessary by a Medicare-approved practitioner. Reimbursable equipment may include:
- Canes and crutches
Does Medicare Cover Alzheimer’s Care for Individuals Who Haven’t Yet Turned 65?
Medicare may provide medical coverage to individuals under the age of 65 if they’re disabled or have end-stage renal disease. These individuals can receive coverage for Alzheimer’s-related services and supplies if they’ve been diagnosed with the disease.
What Alzheimer’s-Related Services Doesn’t Medicare Cover?
Although Medicare covers most care prescribed for the treatment of Alzheimer’s Disease, certain services may not be covered, including:
- Around-the-clock custodial care
- Long-term care at a nursing home or residential skilled nursing facility
- Off-label medications
- Treatments and supplies that aren’t considered medically necessary
What Other Financial Help Is Available for Individuals With Dementia?
Individuals living with Alzheimer’s may be eligible for financial support through several government programs:
- Social Security Disability Insurance: Individuals under the age of 65 who’ve been diagnosed with early onset Alzheimer’s may be eligible for SSDI benefits if they meet other program criteria. The disability decision may be fast-tracked through the Social Security Administration’s Compassionate Allowances program.
- Supplemental Security Income: Disabled seniors age 65 and over who have a limited income and assets may qualify for SSI, which provides monthly benefits to cover basic needs such as food, shelter and clothing.
- Medicaid: Low-income seniors or individuals who’ve used up their savings on long-term care may be eligible to enroll in Medicaid. Because this program combines state and federal funds, eligibility rules and program specifications vary by states. In some areas, individuals under 65 may qualify for Medicaid. Medicaid typically covers long-term care.
Resources Available to Individuals With Alzheimer's and Their Caregivers
If you or a family member has been diagnosed with Alzheimer's disease, there are several resources available to provide education, referrals and other vital assistance.
You can find out more about coverage for Alzheimer's disease care through your medical benefits by contacting your plan's administrator.