Dear Savvy Senior: What exactly does Medicare cover in terms of Alzheimer’s disease? My husband was recently diagnosed with early-stage Alzheimer’s, and we would really like to search out out what’s covered and what is not. – Planning Ahead
Dear Planning: I’m very sorry to listen to about your husband’s diagnosis, but you will be pleased to know that the majority medical costs to treat beneficiaries with Alzheimer’s disease are covered by Medicare. Unfortunately, long-term custodial care costs that the majority patients eventually need usually are not. Here’s a breakdown of what Medicare does and doesn’t cover in terms of Alzheimer’s disease, together with some suggestions that may enable you plan ahead.
Medical care: For probably the most part, ongoing medical care to diagnose and treat Alzheimer’s disease is roofed 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 those costs, and also you might be accountable for the remaining 20 percent after you’ve got met your annual $233 Part B deductible.
Sixty days of inpatient hospital care can also be covered under Medicare Part A after you pay a $1,556 deductible. Beyond 60 days, a day by day coinsurance fee is added.
Medications: Most Alzheimer’s medications are covered under Medicare’s Part D prescription drug plans, but coverage varies so check his plan’s formulary. The one exception is Aduhelm, the controversial recent drug that’s estimated to cost $28,200 per 12 months. Medicare Part B will only cover this drug in case your husband is enrolled in a clinical trial.
Long-term custodial care: It is important to grasp that original Medicare doesn’t cover long-term custodial care. This includes nursing home care, the prices of assisted living facilities and adult day care. Medicare does, nevertheless, pay for some shorter-term nursing home care, but only as much as 100 days following a three-day inpatient hospital stay.
Hiring home help for bathing, toileting and dressing (that is often called custodial care) is just not covered by Medicare either unless your husband can also be receiving skilled-nursing care or physical or occupational therapy.
To assist with these costs, it’s possible you’ll need to look into getting a long-term care insurance policy or short-term care plan (see aaltci.org/stc) if possible, or in case your income and assets are very limited, it’s possible you’ll qualify for Medicaid. To research your financial options for long-term care, go to PayingForSeniorCare.com.
Hospice: In the ultimate stages of the disease, Medicare Part A covers nearly all elements 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 physician must certify that a patient has six months or less to live.
Other insurance and assistance
In case your husband is enrolled in original Medicare and he doesn’t have a supplemental insurance (Medigap) policy, it’s best to consider getting him one. A Medigap plan will help pay for things that are not covered by Medicare like copayments, coinsurance and deductibles. To go looking for plans in your area, go to Medicare.gov/plan-compare and click on on “Medigap policy only.”
Or, in the event you’re enrolled in a Medicare Advantage plan (like an HMO or PPO), his plan must provide him at the least the identical coverage as original Medicare does. Some advantage plans may additionally offer additional coverage for home care services.
In case you cannot afford your Medicare out-of-pocket costs or need assistance with medication expenses, there are Medicare Savings Programs and the Extra Help program that provide financial assistance for medications. To learn more, see Medicare.gov/your-medicare-costs/get-help-paying-costs.
You may 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.
Send your senior inquiries 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 creator of “The Savvy Senior” book.