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Medicare Coverage for Alzheimer’s and Dementia Patients

Alzheimer’s disease and dementia affect millions of seniors in the United States. In fact, the Alzheimer’s Association notes that an estimated 6.7 million Americans over 65 will be living with Alzheimer’s in 2023. 

For those who are diagnosed with Alzheimer’s disease or dementia, there are a lot of factors to consider. These conditions are emotionally draining, both for you and your loved ones. Both Alzheimer’s and dementia affect a person’s memory, thinking, and behavior and can progress over time. 

On top of that, you may wonder how you can treat and slow down the effects of these terrible diseases. 

How can Medicare help cover your treatment? In this article, we’ll discuss what Medicare covers for these conditions and what you need to consider when weighing your coverage options.

What does Medicare coverage for patients suffering from Alzheimer’s and dementia include?

Medicare coverage for Alzheimer’s and dementia patients can vary depending on the type of care needed. Dementia and Alzheimer’s are divided into three separate stages: Early-stage, Mid-stage and Late-stage. Medications and other needs will vary depending on the stage that you are in. 

Here are some of the services that Medicare covers:

Doctor visits 

Medicare covers visits to a primary care physician or specialist, such as a neurologist, who can diagnose and treat Alzheimer’s and dementia. For example, Medicare Part B will cover an annual wellness visit and health risk assessments. This visit can help you get on the path to being diagnosed with Alzheimer’s or a similar condition. 

Diagnostic tests 

Medicare covers diagnostic tests, such as brain imaging scans, necessary to diagnose Alzheimer’s and dementia. Your doctor may need to run several tests to rule out other conditions before you are diagnosed with Alzheimer’s. Strokes and other conditions affecting the thyroid, kidney, and liver can produce dementia-like symptoms, so your doctor must rule those out.

One test that your doctor may recommend is a PET (Positron Emission Tomography) scan. A PET scan is a medical test that can diagnose Alzheimer’s disease in its early stages. Medicare will only cover a PET scan in certain situations, and a doctor must deem it medically necessary. 

Mental health counseling

Many people with Alzheimer’s also suffer from depression, anxiety, and other mental health conditions. Medicare Part B covers 80% of the amount it approves for a mental health service, such as sessions with a psychiatrist or social worker.

Care Planning

Medicare now covers care planning services for newly diagnosed patients. Care planning is provided by such professionals as physicians and nurse practitioners and offers detailed planning that includes:

  • Evaluating your cognitive functions and safety concerns 
  • Measuring your symptoms 
  • Identifying your needs and your caregiver’s needs
  • Planning for palliative care 
  • Referrals to community resources and services for you and your caregiver

Prescription drugs

Alzheimer's and Dementia Patients. Medical Concept on Red Background.

Medicare Part D covers prescription drugs for treating Alzheimer’s and dementia symptoms, such as cholinesterase inhibitors and memantine.

In 2021, the FDA approved a new medication, Aduhelm, for treating Alzheimer’s. Infusion therapy is covered under Medicare Part B as it is given at a doctor’s office or hospital. You may have coverage limits imposed for this treatment. It is very costly, even with Medicare coverage, and will likely increase your Part B premium.  

Inpatient hospital and nursing facility care 

Medicare covers inpatient hospital care for Alzheimer’s and dementia patients who require treatment for related conditions, such as infections or injuries. Medicare also covers up to 100 days of skilled nursing facility care for Alzheimer’s and dementia patients who require rehabilitation or other medically necessary care. You can receive hospice care under Medicare for Alzheimer’s and dementia patients who are terminally ill and have a life expectancy of six months or less.

Home health care

Original Medicare covers eligible home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, and continued occupational services. To qualify for this care, you must: 

  • Be under the care of a doctor under an established and regularly reviewed plan of care; 
  • Receive care from a Medicare-certified home health agency; 
  • Be homebound. Being homebound means that you have difficulty leaving the house because of an illness or injury, or doing so is not medically recommended. 

What does Medicare not cover?

Medicare coverage for patients - Home Health Care for Alzheimer’s and Dementia Patients
Home health care worker and an elderly couple

It’s important to note that while Medicare covers many of the medical services and treatments needed for Alzheimer’s and dementia patients, it doesn’t cover custodial care, including assistance with daily living activities, such as bathing and dressing. That would also include  24-hour home care, home-delivered meals, homemaker services, or personal care. It also does not cover vitamins, supplements, respite care or incontinence supplies.

Special Needs Plans (SNPs)

Special Needs Plans (SNPs) are Medicare Advantage (Part C) plans designed to provide specialized care for specific conditions, such as Alzheimer’s and dementia. They are tailored for these conditions and offer additional benefits, such as care coordination and access to specialists.

The main benefit of an SNP is the availability of care coordination. Managing the different aspects of conditions such as Alzheimer’s and dementia can be a challenge. However, care coordination helps make sure that everyone on your medical team is on the same page and working together to help you.  Some SNPs even include a care coordinator to help you manage your condition. 

Some plans may offer additional services for Alzheimer’s and dementia patients, such as caregiver support services or adult daycare programs. However, you may be limited to doctors in the SNP’s provider network, and, depending on your location,  it may not even be available.

How can The Medicare Family help?

Navigating Medicare coverage options for Alzheimer’s and dementia patients can be overwhelming, especially for families already dealing with the emotional and financial strain of these conditions. That’s where The Medicare Family can help. 

For over 40 years, our team has helped families understand their Medicare coverage options and ensure they received the care they needed. We’ll work with you to determine which Medicare plans and services best suit your needs and budget and understand your options for long-term care, including Medicaid. Book a call today to get started.

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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