What Medicare Covers For Alzheimer’s Patients


As part of retirement planning, all Jewish seniors should think seriously about financial planning for dementia care.


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All too many baby boomers financially under-plan, often out of a belief that Medicare will cover most of their health needs in retirement. It’s important to inform yourself about what Medicare covers for Alzheimer’s patients so that you can plan accordingly. 


As life expectancies grow, the likelihood that we will all spend the last few years of our lives needing some form of long-term care only increases. It’s clear that Western medicine has done a better job at extending the active working life of our bodies than at preventing or curing dementia. We all need to plan ahead, and sadly, the incidence of Alzheimer’s is such that few families will escape. No baby boomer enjoys thinking about the time when we might lose our independence, but the only thing worse than receiving long-term, in-house or residential care is to not receive it when you need it. 


Along with the many other concerns that accompany a diagnosis of the early stages of Alzheimer’s, it is vital to think about finances. Without a clear understanding of what Medicare covers for Alzheimer’s sufferers, it’s impossible to prepare financially for the cost of treatments, long-term or short-term care, hospitalizations, or medications. 


What Medicare Covers

Medicare covers 100% of the cost of annual wellness checks, including cognitive impairment tests. It also covers most of the costs of treatments and medications, but the copayments can vary greatly, so it’s recommended that you check your plan’s total drug costs against those of other plans using the Medicare Plan Finder Tool, to verify that you’re receiving the best possible coverage.


Most treatments and doctor visits are covered by Medicare, including in-patient hospital stays, visits to primary care doctors and specialists, lab tests, speech and occupational therapy, and outpatient counseling services. But – be aware of your deducatibles and copayments. It’s best to review them now, long before you’ll need them, and think hard about what you will be able to pay should you need the services. 


Outpatient nursing care is one confusing aspect of Medicare coverage. Medicare only covers short-term skilled nursing care following hospitalization for a period of up to 100 days, but it does not cover any unskilled nursing care. This has sometimes led to farcical scenes, where a skilled nursing aide visiting to care for a patient’s intravenous line refuses to assist the patient in getting dressed, or even sometimes to put the kettle on.


Medicare Part A does also cover almost all facets of end-of-life hospice care,  including nursing care, doctor services, medications and medical equipment, physical and occupational therapies, and even counseling and respite care. To receive this coverage, the senior suffering from dementia needs certification from a doctor that he/she has less than 6 months to live. 


…What Medicare Does Not Cover …

What Medicare most glaringly does NOT cover is the cost of custodial long-term care, including nursing homes, home helps, and adult daycare centers. Although hospitalizations and treatments can run expensive, the biggest costs come from long-term care, home help aides, and nursing homes. Home health aides who assist dementia sufferers with activities of daily living such as dressing and personal hygiene, and who ensure that they are safe and otherwise in good health, are the most vital piece of the dementia care puzzle, and can be needed for years. 



 …& What You Should Do About It:

The most important thing to do about these gaps in Medicare coverage is to plan ahead for it. Most Jewish seniors will need some form of custodial long-term care for 2-3 years at the end of their life. It is extremely important to acknowledge this, and to plan ahead financially for long-term care. 


The simplest way to cover copayments and deductibles that aren’t paid for by Medicare is to get a Medigap policy. This is a Medicare supplemental insurance policy that is aimed specifically at covering the Medicare Coverage gap (hence the name).


For those who cannot afford to pay for their out-of-pocket Medicare costs, there are government benefits programs that can help with these. Medicaid can also help with long-term care, unskilled nursing care, and other items that are not covered by Medicare, depending on income level.