Dementia is a generalized term in the medical community used for elderly patients with memory issues. Dementia itself is not a specific disease, it’s a generic term used to describe patients experiencing memory decline.
Those with dementia often have a difficult time performing even the most menial of tasks and their acts of daily living usually becomes severely impacted. Those with dementia also suffer from loss of cognitive function, difficulty with reasoning and behavior changes.
As most seniors live on a fixed income, family members often wonder what insurance covers after being diagnosed with dementia or Alzheimer’s.
As Alzheimer’s is the most common form of dementia, the farther along the disease progresses, the more treatment and personal care will be required. Medicare may cover some, not all, of the treatment required from those suffering from dementia or Alzheimer’s.
Medicare Coverage for Dementia
If your dementia or Alzheimer’s requires medically necessary treatment, then Medicare will provide coverage as it would just like any other disease.
If you’re treated in a hospital setting, then your Medicare Part A benefits will cover the hospitalization and any treatment, including medications while there.
If your dementia or Alzheimer’s is treated in an outpatient setting, then your Medicare Part B benefits will pick up coverage for those services.
Specific services covered by Medicare include:
- Diagnostic imaging
- Lab work
- Doctor’s office visits
- Home health care/physical therapy
- Mental health services
- Durable medical equipment (DME)
- Hospice for late stage Alzheimer’s patients
- Annual wellness and health risk assessment
Regardless of whether you are using Medicare Part A or Medicare Part B, coverage is the same. Both cover at 80% regardless of the form of treatment.
What’s Not Covered by Medicare Concerning Dementia
Once dementia patients start to progress, obviously their symptoms worsen. Unfortunately, with worsening memory and a decline in acts of daily living, routine care is often required. Medicare will not provide coverages for any adult caregivers, adult daycares or assisted living facilities.
Respite care, which is temporary care provided out of the home to give the caregiver of the patient a break, also isn’t covered for dementia. However, Medicare benefits will cover respite care for the end stages of Alzheimer’s. At that point your Medicare Part A will allow for hospice and respite care. .
In some cases, there are additional programs that can help provide coverage for services not covered by straight Medicare. There is a patient outreach program called PACE which is a joint program between Medicare and Medicaid.
PACE allows the Alzheimer patient to remain in the comfort of their own home while paying for medically necessary treatments for the patient’s needs.
PACE may also offer added benefits that include, but are not limited to, emergency care, home care, adult daycare, meals and other medical care and therapies. There are some qualifications required in order to be eligible for PACE which you can find out more about here.
How to Get Extra Help with Dementia and Your Medicare Costs
With Medicare not seeming to cover much until the end stages of Alzheimer’s, seniors can avoid some of the added stress of the disease by cutting back on costs.
To get outside coverage for those costs not covered by the Medicare allowable 80%, a Medicare Supplement Plan can be beneficial with assisting in additional healthcare costs.
With rising healthcare costs and SSDI barely covering living expenses, a Medicare Supplement Plan is essential to keep those unwanted out of pocket medical costs down.
You can call our number or fill out our online forms. We make obtaining a supplement insurance plan easy! Let us do all the work and answer any questions you may have. Call or click today, there’s never any obligation to buy and we’re always happy to help!
Interesting Facts About Dementia
Dementia and Alzheimer’s disease are both awful conditions that nobody wants to have to endure. And while there is no cure to date, each year there is millions of dollars spent for funding research on these conditions. According to an online newsletter on healthline:
- There are different forms of dementia. Vascular dementia, mixed dementia, Parkinson’s disease and Huntington’s disease are just a few. The most common form of dementia is Alzheimer’s disease (AD).
- Women have a higher risk of AD then men and It is estimated that approximately 5 million people suffer from AD in the US.
- There are a variety of other medical conditions that can increase your risk of AD. Heart disease, hypertension (high blood pressure), diabetes and high cholesterol are just to name a few.
- Alzheimer’s disease, according to the Alzheimer’s Association, is the 6th leading cause of death for American’s.
- There is no way to predict life expectancy on someone with AD as each individual person’s disease progresses at a different rate.