Does Medicare Cover Alzheimer's Care?

Medicare is an insurance program for people 65 or older who are getting Social Security retirement benefits. It’s also a federal health insurance program for people who are below the age of 65 and who have gotten Social Security disability or Railroad Retirement Board benefits for at least two years. Everyone should apply for Medicare benefits three months before they turn 65 to avoid any delay in coverage. If a Medicare beneficiary develops dementia or Alzheimer’s disease, it’s important to understand that Medicare will help pay for some of the costs associated with care. 

Medicare Benefits Solutions

Feb 11, 2021

 4 minutes read

Medicare benefits and Alzheimer’s care coverage

It’s very important that you know what Medicare will and won’t cover in terms of Alzheimer’s care. 

  • Medicare insurance will cover some medical items, doctor’s fees, and inpatient hospital care for people with dementia or Alzheimer’s who are 65 years old and older. 
  • Medicare Part D will help cover the cost of prescription drugs.
  • Medicare will cover the cost of having hospice delivered to your home, inpatient hospice facility, or to a nursing facility for people who have Alzheimer’s and their primary care doctor determined that they’re near the end of their lives. 
  • Medicare will cover up to 100 days of care at a skilled nursing home under specific and limited circumstances. However, it won’t cover the cost of long-term care in a nursing home. 

Health risk assessment and annual Wellness Visit coverage

You can have an annual Wellness Visit once every 12 months with Medicare, and it will cost you nothing. Before or during this visit, the doctor can ask the caregiver or Medicare beneficiary to complete a Health Risk Assessment. This assessment will include some questions about a person’s health. The information the health professional gets could give them important insight to further the discussion during the visit. Your doctor can also use this information to start the diagnostic process. Caregivers can play an important role here, too. They can give the doctor information before the doctor to help ensure a thorough assessment of the patient. 

Care plan services and cognitive assessment coverage

Medicare offers coverage for care planning services for any beneficiary who recently had a cognitive impairment diagnosis like dementia or Alzheimer’s. Care planning allows both the patient and their caregiver an opportunity to learn about various non-medical and medical treatments, community services available, and clinical trials. They can also provide additional information or support that can increase the patient’s quality of life. 

Medigap plans and Alzheimer’s coverage

You can supplement your Original Medicare coverage with Medigap plans. Medigap, or Medicare Supplement plans, are sold by private insurance companies to help cover some of the costs that Part A and Part B do not include. 

Medicare Part C coverage

Medicare Part C gives you the choice of enrolling in a Medicare Advantage plan as an alternative to Original Medicare. You can choose from different types of MA plans, including a Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), and a Point-of-Service plan. Medicare Advantage plans are required to provide at least the same coverage as Original Medicare Part A and Part B, but approves many plans include additional coverage. Additional benefits may include vision and dental care, fitness programs, and prescription drug coverage. However, they may come with limits on which doctors, health care providers, and hospitals you can use for your care. 

You should compare each plan very carefully to learn about which Medicare options are available to you and which would work best for Alzheimer’s care. There are Special Needs Plans for Alzheimer’s disease available. These Special Needs Plans are Medicare Advantage plans that are designed to provide specialty care for people with certain diseases or chronic conditions. These are Medicare Advantage plans that specialize in coverage and care for people with these cognitive impairments. If it sounds like something would benefit you, don’t be afraid to check into it when you start weighing your options for Medicare benefits.

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