By JIM MILLER
(SAVVY SENIOR) Most medical costs to treat beneficiaries with Alzheimer’s disease are covered by Medicare. Unfortunately, long-term custodial care costs that most patients eventually need are not. Here’s a breakdown of what Medicare does and doesn’t cover when it comes to Alzheimer’s disease, along with some tips that can help you plan ahead.
For the most part, ongoing medical care to diagnose and treat Alzheimer’s disease is covered by Medicare Part B, including visits to primary care doctors and specialists, lab tests, speech and occupational therapy, home health care, and outpatient counseling services. Medicare pays 80 percent of these costs, and the patient will be responsible for the remaining 20 percent after they’ve met their annual $233 Part B deductible.
Sixty days of inpatient hospital care is also covered under Medicare Part A after you pay a $1,556 deductible. Beyond 60 days, a daily coinsurance fee is added.
Most Alzheimer’s medications are covered under Medicare’s Part D prescription drug plans, but coverage varies, so check your plan’s formulary. The only exception is Aduhelm, the controversial new drug that is estimated to cost $28,200 per year. Medicare Part B will only cover this drug if the patient is enrolled in a clinical trial.
Long-Term Custodial Care
It’s important to understand that original Medicare does not cover long-term custodial care. This includes nursing home care, the costs of assisted living facilities, and adult day care. Medicare does, however, pay for some shorter-term nursing home care, but only up to 100 days following a three-day inpatient hospital stay.
Hiring home help for bathing, toileting, and dressing (this is known as custodial care) is not covered by Medicare either, unless also receiving skilled-nursing care or physical or occupational therapy.
To help with these costs, you may want to look into getting a long-term care insurance policy or short-term care plan (see aaltci.org/stc) if possible, or if your income and assets are very limited, you may qualify for Medicaid.
To investigate your financial options for long-term care, go to PayingForSeniorCare.com.
In the final stages of Alzheimer’s, Medicare Part A covers nearly all aspects of hospice care, including doctor services, nursing care, drugs, medical equipment and supplies, physical and occupational therapy, homemaker services, counseling, and respite care. To qualify, a doctor must certify that a patient has six months or less to live.
Other Insurance and Assistance
If someone with Alzheimer’s is enrolled in original Medicare and doesn’t have a supplemental insurance (Medigap) policy, consider getting them one. A Medigap plan will help pay for things that aren’t covered by Medicare, like copayments, coinsurance, and deductibles. To search for plans in your area, go to Medicare.gov/plan-compare and click on “Medigap policy only.”
Or, if they are enrolled in a Medicare Advantage plan (like an HMO or PPO), their plan must provide at least the same coverage as original Medicare does. Some advantage plans may also offer additional coverage for home care services.
If you can’t afford the Medicare out-of-pocket costs or need help with medication expenses, Medicare Savings Programs and the Extra Help program provide financial assistance for medications. To learn more, see Medicare.gov/your-medicare-costs/get-help-paying-costs.
You can also get help through your State Health Insurance Assistance Program (see ShipHelp.org or call 877-839-2675), which provides free Medicare and long-term care counseling. MSN
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of the book, The Savvy Senior.