Memory Care and Medicare: What You Need to Know
According to the Center for Disease Control and Prevention, Alzheimer’s disease, which affects parts of the brain that control memory, thought and language, is the most common form of dementia. In 2018, more than 5.7 million Americans are already living with Alzheimer’s disease and this is projected to reach 7.1 million by 2025.
With this growing number also comes the increasing cost of caring for individuals with Alzheimer’s disease or other forms of dementia including memory care assisted living, which is expected to reach a staggering $277 billion.
Alzheimer’s care is definitely expensive, which brings this question to mind: will Medicare cover memory care for beneficiaries with Alzheimer’s or dementia? Yes, Medicare will pay for memory care cost, but not all of it.
Here’s what you should know:
Early Stage Alzheimer’s Disease
- If you’re enrolled in Medicare Part B, you will be covered for annual wellness visits, which will include a health risk assessment that usually determines the symptoms that lead to the diagnosis of early-stage Alzheimer’s disease. After a diagnosis is made, your doctor will offer advice on advance care planning options.
- Medicare Part B will cover 80% of the cost of diagnostic tests to rule out other conditions and diagnose Alzheimer’s disease and its progression. This includes PET scans, CT scans and MRIs that are ordered by a doctor and provide useful information that will help in proper care planning.
- Part B will pay for 100% of the approved amount for annual depression screenings provided that your doctor accepts the assignment and you get it in a primary care setting. Part B also covers all doctor visits and follow-ups and so are mental health services including counseling and occupational health therapies as long as the doctor prescribes them.
- Medicare Part A covers inpatient care, but this might include co-payments, co-insurance costs, and deductibles depending on the type and cost of services needed. The coverage also includes all drugs prescribed during your hospital stay.
- Only Medicare Part D, which is usually from private insurance companies, is needed for covering prescription drugs to take at home.
Middle-Stage Alzheimer’s Disease
- Medicare offers very limited coverage during middle-stage Alzheimer’s disease. Full-time nursing care is not covered and only limited home health coverage is available and will depend upon the patient’s situation.
- Medical care and health services prescribed by the doctor during the early stage of the disease will continue through the middle-stage.
Late-Stage Alzheimer’s Disease
- In terms of memory care assisted living, Medicare doesn’t generally cover full-time nursing home care but offers skilled nursing care in some situations. Medicaid programs run by the state may cover long-term services, however, especially for beneficiaries with limited income. Medicare covers up to 100 days in skilled nursing homes under limited circumstances. Hospice care delivered at home, a hospice facility or nursing facility for patients who are determined by the doctor to be near the end of life is also covered by Medicare.
- For patients in late-stage Alzheimer’s, Medicare will cover the cost of home health care for up to 35 hours a week provided that the patient is certified as “homebound.”
It’s very important to know the in-betweens of Medicare coverage for patients with Alzheimer’s disease to know which options will best help cover the cost of caring for patients with Alzheimer’s including memory care assisted living.
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