Dementia is a decline in mental capacity that becomes severe enough to hinder a person’s ability to function. According to the Alzheimer’s Association, one-third of Americans die with some form of dementia. Medicare Parts A and B (Original Medicare) will cover everything that’s medically necessary for dementia patients, but many services won’t be covered. While Original Medicare dementia care is limited, certain Medicare Advantage plans offer coverage for more services that can include unexpected offerings like meal delivery.
Medicare Coverage for Dementia Patients Clarified
Medicare will cover services that your doctor deems medically necessary. Medicare Part A covers inpatient hospital care, and Medicare Part B covers outpatient care and medical expenses such as doctors’ appointment costs. Original Medicare will pay for the first 100 days of care in a skilled nursing facility (there may be some associated fees), and some Medicare Advantage (Part C) plans may include long-term care coverage. Private insurance companies offer Medicare Advantage plans, so they have the freedom to cover benefits Original Medicare doesn’t. Medicare Part D or certain Medicare Part C plans cover prescription drugs such as cholinesterase inhibitors that can temporarily improve symptoms of dementia.
Medicare Supplements (Medigap) plans can help cover the expenses that Original Medicare does not. Unlike Medicare Advantage plans, Medigap plans do not cover medical expenses, but they cover financial items such as Part A and B coinsurance and copayments. Even though Medigap and Medicare Advantage are two different types of plans, you cannot enroll in both at the same time.
Medicare Testing for Dementia
Medicare Part B covers cognitive testing for dementia during annual wellness visits. A doctor may decide to perform the test for patients who are experiencing memory loss. The test consists of about 30 questions like, “What year is this?” to assess the patient’s memory and awareness. The test can be used as a baseline evaluation for future wellness visits and can be a valuable tool for catching dementia early.
Testing for Alzheimer’s
Dementia is a symptom that can result from many different diseases. Alzheimer’s disease is just one cause of dementia. The risk of developing Alzheimer’s increases with age and with a family history of Alzheimer’s. There is a correlation between genes called apolipoprotein E (APOE) and Alzheimer’s, but those genes do not necessarily cause the disease. Medicare will not cover genetic testing for APOE genes.
Dementia as a SEP-Qualifying Condition
Medicare eligibles with dementia also qualify for specific Medicare Advantage plans called Chronic Special Needs Plans (CSNPs). These health insurance plans involve coordination and communication between the patient’s entire medical team to help ensure the patient gets the best possible care. The best way to sort through the thousands of plans available and find the right CSNP for you is enlisting the help of a qualified professional by contacting us here.
If you’re diagnosed with dementia and already enrolled in Medicare Parts A and B, you will qualify for the Special Enrollment Period (SEP). The SEP allows you to enroll in new Medicare coverage or make changes to your existing CSNP whenever you need to instead of having to wait for certain times of the year.
Does Medicare Cover Assisted Living or Nursing Homes for Dementia?
No, Original Medicare does not cover assisted living for dementia patients. However, certain Medicare Part C plans may include coverage for Medicare dementia care services such as adult day care or help to get dressed or to bathe.
Medicare will not cover nursing home stays, and even the most comprehensive Medigap plan won’t cover long-term care. However, Medicare will cover medical services while the patient lives at a nursing home.
Medicare Dementia Hospice Criteria
Families of dementia patients have access to a wide variety of resources to help them cope. The first step for helping your loved ones is to educate yourself about the disease and to learn how you can be the most supportive. You should also look into support groups for your family so they can find like-minded people who are having similar experiences. Dementia should not be dealt with alone.
You should consider important things such as who will have the power of attorney and make financial decisions for the patient at the end of his or her life. If you haven’t enrolled in a life or a final expense insurance policy, you should consider doing so now.
We Can Help
Dementia is difficult for everyone involved. If you or a loved one has dementia, we can help you navigate Medicare dementia care and find a Chronic Special Needs Plan that’s right for you. Set up a no-obligation appointment with a benefits advisor by calling 833-438-3676 or contacting us here today.