Medicare and Alzheimer’s: How Coverage Works

When it comes to Alzheimer’s disease, some seniors wonder what Medicare covers and what supplemental insurance might be needed. For a person who has Alzheimer’s disease, it is important to know that Medicare will cover some of the costs of medical care, but not all of them.

Medicare and Alzheimer’s: How Does it Work?

Medical coverage

Senior who have Medicare Part A and B will have most of their medical costs for diagnosis and treatment covered. These costs can include doctor visits, medical services like lab tests, speech and occupational therapy and outpatient services and care. Seniors who pay a Part B deductible are usually responsible for 20 percent of their medical costs, while Medicare will cover the remaining 80 percent. In a recent change under the Affordable Care Act, all preventive services for senior wellness are completely covered by Medicare and won’t cost seniors anything out of pocket.

Long term care

While a large portion of medical costs are covered by Medicare, some seniors with Alzheimer’s disease might be in need of long term care after time spent in a hospital. Outpatient care and short-term services are covered by Medicare, but most seniors will have to pay the majority of the cost of long term care with Medicare help. As a result, many invest in supplemental insurance in order to cover the cost of long-term care. Medicare will cover a person’s stay at a skilled nursing facility or healthcare in the home setting for a short stay if it is deemed medically necessary and the person qualifies.

Prescription drug plans

While most Alzheimer’s medications are covered in Medicare’s prescription drug plans, seniors have to invest in these plans separately from Part A and Part B. Part D drug plans provide coverage up to a certain amount, but once that amount is reached, seniors are often left paying much of the cost themselves. This limit is called the donut hole once it is reached and can be very expensive for some seniors. Under new healthcare law changes, the donut hole will be phased out of existence by 2020 and will shrink every year until then. Currently, Part D prescription drug plans will cover the first $2,970 of medications before a beneficiary reaches the coverage gap. Some seniors also invest in supplemental insurance depending on their prescription medicine needs.

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Pete Blasi