How does Medicare provide coverage for Alzheimer’s patients?

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If you or a loved one have been diagnosed with Alzheimer’s disease, you’re probably wondering what services a Medicare insurance plan will help cover so you don’t have to worry financially.

Medicare itself doesn’t have a specific category of coverage dedicated to covering Alzheimer’s disease, and it doesn’t cover long-term care. But it does offer some coverage for medical services that help Alzheimer’s patients.

So, what does Medicare cover?

Before a diagnosis for Alzheimer’s can be put in place, the tests to determine if Alzheimer’s is the proper diagnosis can be quite expensive. These tests can include a variety of definitive tests and mental evaluations used to out rule other conditions. Since these tests are considered a diagnostic process, 80% of the costs will be covered by Medicare Part B, until the patient has reached their deductible.

Part B will also cover 80% of physical and occupational therapies if it is medically necessary.

If you have Medicare Part C, you’ll receive the same benefits and coverage as you would from Medicare Part A and Part B, but you could also receive additional services not offered by Part A or B. Make sure to contact your plan and confirm if additional coverage is provided for you or your loved one’s care.

With Medicare Part D, you can receive coverage for drugs prescribed by your doctor that are not covered by Part B, such as outpatient drugs that help ease your symptoms.

As Alzheimer’s disease progresses into the middle-stage, the care requirements for the patient also progresses. Even though Medicare will continue to cover doctor appointments and specific prescriptions, it will not cover assisted living, whether that be at home or in a memory care residence. 

When an individual enters into late-stage Alzheimer’s, there become more services that Medicare will cover, but some coverage comes with restrictions. Nursing home care is covered, but only for 100 days, and it has to follow a hospital stay. If the individual requires home health care, then Medicare will cover health care up to 35 hours a week, as long as the individual is considered to be homebound.

If the individual has less than six months to live, Medicare will offer a hospice benefit that includes all the necessary care and services that the individual needs.

Remember to always confirm with your Medicare plan regarding what services will be covered.

What should I do if I’ve been diagnosed with Alzheimer’s disease?

Being diagnosed with Alzheimer’s disease can cause a roller coaster of emotions of anger, sadness, and even isolation. But even though the disease isn’t curable, there are still treatments available that can slow the progression so you can live your life the way you should. 

You also shouldn’t blame yourself. Alzheimer’s disease isn’t something you can choose to have, and it certainly doesn’t have to take away your identity. Keep embracing the things you love that define your sense of self.

Have questions about your coverage?

If you have any questions regarding coverage with Medicare, our well-trained and experienced agents are here to give you the answers you need. Give us a call today at 662-844-3300.

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Justin Brock

President & CEO of Bobby Brock Insurance