Does Medicare Cover Dementia Care?

If you or a loved one is diagnosed with Alzheimer’s disease or a form of dementia, it can alter your wants and needs greatly. Not only will you need to account for treatment of dementia, you may need to plan for care or the potential for the condition to advance. Not only can this be stressful, but it can also be expensive and exhausting. Luckily, if you’re enrolled in Medicare, there are many ways that whatever type of plan you have will offer some sort of coverage.

Coverage of Early Stages and Assessment

In the earliest stages of the illness, assessment and diagnosis are the most important steps of treatment. After determining what illness you have, you and your doctor can work together to figure out a treatment plan as early as possible. For this reason, Medicare helps cover numerous ways for doctors to assess and watch for signs of dementia. One of these is the Annual Wellness Visit, when your primary care physician updates your care plan and updates any health risk assessment information you may need. This may include cognitive impairment tests. If ordered by your doctor, Medicare may also help cover other diagnostic tests, like PET scans.

Medicare helps cover numerous ways for doctors to assess and watch for signs of dementia.

Mental health issues like depression or anxiety are more common in dementia patients than people without dementia. Fortunately, Medicare helps cover qualifying mental health treatments, both inpatient and outpatient.

Caregiving

Twenty-four states and territories now provide training for families and caregivers of dementia patients.

Medicare can also help with another important facet of living with dementia, caregiver support. Caregiving can be incredibly difficult, especially as the condition progresses, and without help or proper training, the care given may be ineffective or even dangerous. That’s why 24 states and territories now provide training for families and caregivers of dementia patients, to help them remain at home and comfortable as long as possible. If you live in a state or territory that’s not included in that list, Medicare.gov provides guidance as to where caregivers can receive additional assistance.

Skilled Nursing and Inpatient Care

At some point, the dementia may advance to the point that professional help is needed. Luckily, Medicare can help cover this, too. For example, Medicare can help cover home health care services. Essentially, your doctor must certify that you need intermittent skilled nursing care or another type of therapeutic care and are homebound. If you or your loved one has reached the end stage of dementia, you may also qualify for hospice or palliative care, which Medicare can help cover as well.

For Original Medicare, there are a number of conditions that need to be met for inpatient skilled nursing coverage.

Eventually, it may be necessary to start receiving care in an inpatient setting. Unfortunately, Medicare is a little more limited in its coverage of this type of care. For Original Medicare, there are a number of conditions that need to be met, including a preceding hospital stay, to qualify beneficiaries for coverage. If you do qualify for some coverage, you’ll only be covered for a limited time, depending on how long you need skilled nursing facility care and your benefit period usage.

Medication

While Original Medicare doesn’t cover prescription drugs, you may still have medication needed for dementia or Alzheimer’s disease treatment covered. You may be able to achieve this by using either a Medicare Advantage plan or a Medicare Part D plan. The specifics of both coverages depend on your individual plan, since both are offered by private insurance companies (though approved by the federal government). That said, if you have either of these types of plans, it is likely you’ll have your prescriptions covered in some way, though it pays to ask questions and research before choosing a plan.

Special Needs Plans and Extra Coverage

In special circumstances, like a dementia or Alzheimer’s disease diagnosis, you may also be eligible for certain types of plans that may fit your needs better than traditional Original Medicare coverage. For qualifying beneficiaries, a Medicare Special Needs Plan (SNP) may offer the care you need at an affordable price. Specifically, C-SNPs (Chronic Condition Special Needs Plans) are designed to cover the needs of beneficiaries with chronic illnesses like dementia. These plans often include like customized health benefits, specialized provider networks and drug formularies, and special cost-sharing structures. If you think you’ll likely need care in a facility for 90 days or more, you may also qualify for an I-SNP (Institutional Special Needs Plan), which covers many of the costs associated with care facilities.

For qualifying beneficiaries, an SNP or a PACE plan may offer the care you need at an affordable price.

Another option, if you fit the eligibility requirements, is PACE. PACE, or Programs of All-Inclusive Care for the Elderly, focuses on providing health care services in a beneficiary’s home or “in the community.” To qualify for PACE coverage, you must be at least 55, live in a PACE service area, and be certified by your state to need nursing home-level of care. If you get a PACE plan, you’ll be given an interdisciplinary team that will help cover many facets of your care, possibly including different types of therapists, a dietician, and/or a personal care attendant.

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As you can see, if you or a loved one is diagnosed with dementia or Alzheimer’s Disease, there are many aspects of care that need to be accounted for. Luckily, Medicare is comprehensive enough that many of these may be covered in some way. A diagnosis can be a life-changing event, but it doesn’t have to be life-ending, in a sense. With the assistance of Medicare, your family, and your caregivers, a happy, fulfilling life is still a real possibility.

Further Reading

Medicareful Living — Caregiving for a Loved One with Alzheimer’s on Halloween
Medicareful Living — Caregiving for a Loved One with Dementia
Medicareful Living — How to take Part in Alzheimer’s Action Day
Medicareful Living — Senior Delirium: Confusing, Scary, and All Too Common
Medicareful Living — Simple Tips to Stay Mentally Sharp
Medicareful Living — Why a Smart Home is a Safe Home: Dementia Caregiving