Alzheimer’s disease can be a scary diagnosis. Today in the United States, there are around 6.5 million people over the age of 65 who are living with Alzheimer’s disease. Unfortunately, there is no cure for the disease, but there are medicines that can help slow its progression and improve symptoms.
A progressive brain disorder, Alzheimer’s is the most common cause of dementia. This devastating disease affects a person’s memory, behavior, social skills, and motor skills. It slowly causes a decline in cognition, typically leading to more serious memory problems and an inability to function independently.
Medication and treatments that may be available to help you live safely and comfortably at home. When that is not an option, many nursing homes offer specialized care for patients with Alzheimer’s who can no longer live independently or stay in their own homes.
If you or a loved one has been diagnosed with Alzheimer’s disease, you should be aware of how your Medicare insurance can help you with benefits from diagnosis to long-term skilled nursing care.
How does Medicare cover Alzheimer’s care?
Here is a look at how Original Medicare Parts A (hospital insurance) and B (medical insurance) cover Alzheimer’s care services:
Medicare Part A
- Inpatient hospital stays on a short-term basis. To be eligible for this coverage, you must be admitted to the hospital after an official order from a physician who certifies that you need inpatient care. The hospital must accept Medicare assignment.
- Short-term stays at a Medicare-affiliated skilled nursing facility.
- Physical, occupational, and speech therapy sessions that you receive during an inpatient stay at a hospital or skilled nursing facility.
- Prescription medications that you take while you’re an inpatient at a hospital or skilled nursing facility.
- Home health care services if you meet the conditions set by Medicare. These services do not include custodial care.
- Hospice care services.
Medicare Part A covers costs for the above-mentioned care services after you cover the Part A deductible for the current benefit period. As of 2024, the Part A deductible is $1632. You are also required to pay a daily copayment after the 60th day of hospital inpatient care. In 2024, days 61-90 carry a copayment of $408 daily; days 91 and beyond carry a copayment of $816 for each lifetime reserve day. You must pay 100 percent of all costs after your lifetime reserve days end.
Medicare Part A covers 100 percent of the cost of home health care services if you are homebound.
Medicare Part B
- Outpatient screening exams
- Outpatient laboratory diagnostic exams
- Visits to physicians and specialists
- Outpatient services and care related to Alzheimer’s treatment
- Outpatient prescription drugs that are administered by your health care provider in a medical office or clinic that accepts Medicare assignment
- Outpatient physical, occupational, or speech pathology therapy sessions
- Outpatient and inpatient mental health care services
- Medically necessary durable medical equipment
Original Medicare Part B pays 100 percent of the cost for a wide range of preventive and screening services including exams, shots, and lab tests. Depending on where you have your tests done, you might be required to pay a copayment to the hospital or medical clinic.
Medicare Part B pays 80 percent of the final approved cost for the other health care services listed above. You pay the remaining 20 percent after meeting the annual deductible for Part B. In 2024, the Part B deductible is $240.
If you’re enrolled in Original Medicare Parts A and B, you must be enrolled in a stand-alone Medicare Part D (prescription drug) plan to get coverage for prescription drugs you need to treat the symptoms of Alzheimer’s disease.
Medicare Advantage coverage of Alzheimer’s care
Medicare Advantage (MA)covers all the Alzheimer’s services that are covered by Original Medicare Part A and Part B. Many MA plans offer additional coverage for more days of skilled nursing care or inpatient hospital care. You may also have different coinsurance and copayment costs through your MA plan.
Most Medicare Advantage plans also cover prescription drugs. Other additional benefits that may be offered by your MA plan include routine dental visits, vision and hearing care, fitness programs, and more.
Your Medicare Advantage plan may require that you use network health care providers and medical suppliers in order to receive your benefits. If you don’t know which providers are included in your plan, you should contact your provider for assistance.