Choosing Medicare for Ones with Alzheimer's Disease

Alzheimer’s disease is a chronic, debilitating brain disease that impacts 6.2 million Americans and their families. If you or your loved one has been diagnosed with this or another type of dementia, Medicare will help cover medical and mental health services, medical supplies, and prescription drugs.

Key takeaways:
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    People with Original Medicare and Medicare Advantage can have a cognitive assessment with their free yearly wellness visit.
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    Older people and their caregivers should execute advanced healthcare directives to reduce uncertainty involving healthcare decisions.
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    Eligible individuals with Alzheimer’s disease can join a Medicare Special Needs Plan (SNP) at any time.
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    Medicare may not cover the costs of services that you need, such as personal assistance and long-term care.

Your healthcare team and community resources can also help you get the most out of your Medicare plan.

Cognitive assessment for Alzheimer’s disease

During your free annual wellness visit under Medicare, your healthcare provider might perform a cognitive assessment for signs of memory impairment. These include:

  • problems concentrating, learning new things, or remembering.
  • trouble making everyday decisions.
  • difficulty with managing finances and personal affairs.

Medicare Part B also covers a more thorough examination by your doctor or a specialist to establish or confirm an Alzheimer’s disease diagnosis. At this point, your healthcare professional will help you set up a care plan for managing symptoms, make advance care plan arrangements, and learn about community resources.

After meeting your Part B deductible, you’ll pay 20% of the Medicare-Approved Amount.

Advance health care directives for individuals with Alzheimer’s

Advance directives for health care are written records of a person’s health care preferences. These documents become effective after the person becomes unable to make their own decisions. The person must be legally able to execute their health care directives, which may include:

The living will: outlines a person’s wishes for medical care if the person becomes permanently unconscious and unable to decide regarding emergency treatment.

A durable power of attorney for health care: appoints an agent or proxy to make health care decisions on a person’s behalf if the person is unable to do so.

Do Not Resuscitate (DNR) order: instructs health care professionals not to perform CPR if a person’s pulse or breathing stops.

Caregivers should ensure that the person with Alzheimer’s disease has authorized Medicare agents, doctors, and attorneys to communicate with the caregiver. This lets the concerned parties discuss bills, health insurance claims, and care.

Medicare SNP for Alzheimer’s patients

People with Alzheimer’s disease can enroll in a Medicare Special Needs Plan (SNP). Medicare SNPs are Medicare Advantage or Part C plans that limit membership to people in certain groups, such as individuals with this dementia. You can join at any time.

To join a Medicare SNP, you must have Medicare Parts A and B, live in the plan’s service area, and meet eligibility criteria for either a:

Chronic Condition SNP (C-SNP): for people with one or more severe, disabling, and chronic conditions, including dementia and specific mental health and neurologic issues.

Institutional SNP (I-SNP): for people who live in the community but need institutional-level care.

Dual Eligible SNP (D-SNP): for people who qualify for both Medicare and Medicaid.

Medicare SNPs cover all the services that Medicare Advantage plans must provide, including prescription drugs. They may also have extra services tailored to their special group. Some SNPs require choosing a primary care doctor or referrals to specialists, while others cover out-of-network services. Check plans for details.

Medicare SNP costs and availability

Private insurers manage Medicare SNPs, so availability, benefits, and costs can differ among companies and locations. Insurance companies join or leave Medicare every year, so a particular SNP may or may not always be offered near you.

You can expect to pay the exact costs that come with a Medicare Advantage plan. If you have Medicare and Medicaid, however, most of your expenses will be covered.

What Medicare won’t cover for Alzheimer’s disease

People with Alzheimer’s may need services that Medicare does not cover. They or their families will have to pay out of pocket for such expenses if the patient does not have Medicaid or long-term care insurance.

Medicare does not cover:

Personal care or custodial care: including paying someone to help with bathing, dressing, and other daily tasks.

Long-term care: including adult day care, nursing home stays over 100 days, and assisted living costs.

Early planning for people with Alzheimer's disease

Alzheimer’s disease and dementias affect each person differently, so it’s not possible to predict how fast or severely their ability to manage their health care may decline. Some people with even early dementia may not be emotionally or cognitively capable of dealing with difficult decisions. It’s best to make and update arrangements now so you can handle current issues and set up the next steps.

You may have to use in-home and long-term care, which may include a personal care assistant or home health aide. As your loved one’s disease progresses, you might want to consider assisted living communities, memory care, or nursing homes. However, Medicare may not cover these arrangements unless you need and get skilled care.

Consider getting help from a geriatric care manager experienced in such situations. These trained specialists can act as “professional relatives” to help you build a long-term care plan and access appropriate services. Some Medicare SNPs use care coordinators to help beneficiaries find information and access services.

Alzheimer’s disease is a progressive brain disorder with no known cure. Healthcare costs for Alzheimer's patients are on the rise, adding to the financial and emotional burden of managing the disease. Medicare-sponsored services can help relieve this strain and foster the optimal health, well-being, and dignity of loved ones facing memory loss.

Advance care planning resources for people with Alzheimer’s

Support for your Alzheimer’s journey is only a click or phone call away. Local social service agencies can offer advice or referrals to organizations that can help. Check out Alzheimers.gov for free information and assistance.

Resources:

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