Smart Seniors: How Medicare Covers Alzheimer’s Disease

Dear chess great,
What exactly does Medicare cover when it comes to Alzheimer’s disease? My husband was recently diagnosed with early-stage Alzheimer’s disease and we would like to know what is covered and what is not.
Planning for the future

Dear Planning,

I’m so sorry to hear about your husband’s diagnosis, but you’ll be happy to know that most medical costs for treating Alzheimer’s recipients are covered by Medicare. Unfortunately, the long-term custodial care costs that most patients ultimately need are not. Here’s a breakdown of what Medicare does and doesn’t cover when it comes to Alzheimer’s disease, along with some tips that can help you plan ahead.

medical care: For the most part, ongoing medical care for the diagnosis and treatment of Alzheimer’s disease is covered by Medicare Part B, including visits to primary care physicians and specialists, lab tests, speech and function therapy, home health care, and outpatient counseling services. Medicare pays 80 percent of these costs, and you’ll be liable for the remaining 20 percent after you meet the $233 annual Part B deduction.

Sixty days of inpatient hospital care is also covered under Medicare Part A after paying the $1,556 deductible. After 60 days, the daily co-insurance fee is added.

pharmaceutical: Most Alzheimer’s drugs are covered under Medicare Part D prescription drug plans, but coverage varies, so check their plan brochure. The only exception is Aduhelm, the controversial new drug that is estimated to cost $28,200 a year. Medicare Part B will only cover this drug if your spouse is enrolled in a clinical trial.

Long Term Nursery Care: It is important to understand that original Medicare does not cover long-term internment care. This includes nursing home care, the costs of living facilities and adult day care. However, Medicare pays for some of the costs of short-term home hospice care, but only up to 100 days after a three-day hospital stay.

Medicare does not cover using home help for bathing, toileting, and dressing (this is known as custodial care) unless your spouse also receives skilled nursing care, physical or occupational therapy.

To help with these costs, you may want to consider taking out a long-term care insurance policy or a short-term care plan (see aaltci.org/stc) if possible, or if your income and assets are very limited, you may qualify for Medicaid. To investigate your financial options for long-term care, go to PayingForSraduateCare.com.

Hospice: In the final stages of illness, Medicare Part A covers nearly all aspects of hospice care, including physician services, nursing care, medications, medical equipment and supplies, physical and occupational therapy, housewife services, counseling, and respite care. To qualify, a physician must certify that the patient has six months or less to live.

Insurance and other assistance

If your spouse is enrolled in Original Medicare and does not have supplemental insurance (Medigap), you should consider getting it. Medigap will help pay for things that Medicare doesn’t cover like co-payments, coinsurance, and deductibles. To find plans in your area, go to Medicare.gov/plan-compare and click “Medigap Only Policy.”

Or, if you’re enrolled in a Medicare Advantage plan (such as an HMO or PPO), his plan must provide him with at least the same coverage as original Medicare. Some benefit plans may also offer additional coverage for home care services.

If you can’t afford your Medicare out of pocket or need help with drug expenses, there are Medicare Savings and Supplemental Assistance Programs that provide financial assistance for medications. To learn more, see Medicare.gov/your-medicare-costs/get-help-paying-costs.

You can also get help through the state’s Health Insurance Assistance Program (see ShipHelp.org or call 877-839-2675), which provides free medical consultations and long-term care.

Send your key questions to: Savvy Senior, PO Box 5443, Norman, OK 73070 or visit SavvySraduate.org. Jim Miller is a contributor to NBC today Show and author “The Savvy Senior” the book.

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