Alzheimer’s disease and dementia care: 5 Medicare benefits consumers should know
2024年6月20日 - 12:10AM
With the Food and Drug Administration’s approval of new
medications like Leqembi, there’s increased focus on ways Medicare
can help alleviate the significant costs of Alzheimer’s and
dementia care. Today, during June’s Alzheimer’s and Brain Awareness
Month, medicareresources.org is spotlighting important
Medicare benefits that many people may not know about.
“Alzheimer’s disease and other forms of dementia can come with a
heavy financial burden as well as an emotional toll, which is why
it’s critical patients and families understand when and how
Medicare can help mitigate costs,” said Louise Norris, a health
policy analyst for medicareresources.org. “People may be
surprised, especially about new coverage of diagnostic tests and
medications."
Nearly 7 million Americans live with Alzheimer’s disease, the
most common form of dementia. The total cost for care in 2024 is
projected to reach $360 billion, with an estimated 45% paid by
Medicare and 25% paid out of pocket by consumers, according to data
aggregated by the Alzheimer’s Association.
For families anxious about those out-of-pocket costs,
learning what Medicare covers can provide significant
relief. Here are five critical benefits medicareresources.org says
consumers might not know about:
1. Drug coverage
Medicare covers FDA-approved medications to treat dementia
and cognitive impairment. This includes Leqembi, an infusion
treatment of early Alzheimer’s disease that recently received full
FDA approval. There are some conditions for Medicare coverage
of these drugs, including a requirement for the prescribing
physician and clinical team to participate in a registry to help
assess how medications are helping people. Approved Alzheimer’s and
dementia medications that are self-administered are covered
under Medicare Part D prescription drug coverage. Medications
that are administered in a medical office, such as infusions,
are covered by Medicare Part B medical coverage.
“Medicare drug coverage is an area where beneficiaries have a
certain level of choice because they can select from a variety of
Medicare Advantage plans or Part D prescription plans,” said
Norris. “It may be to your advantage to compare plans and choose
one that maximizes your medication coverage and saves you from
spending money out-of-pocket.”
Medicare Advantage and Medicare Part D selections can be made
during a person’s initial enrollment period when they become
eligible for Medicare, or during the annual election period
Oct. 15 to Dec. 7 each year. Additionally, beneficiaries
enrolled in Medicare Advantage plans can make coverage changes
during the Medicare Advantage Open Enrollment Period, from Jan. 1
to March 31.
2. PET scans
Medicare Part B covers a range of testing and imaging
for diagnosing dementia, including beta amyloid positron emission
tomography (PET) scans. In fact, the Centers for Medicare &
Medicaid Services (CMS) announced in October that it was expanding
access to this covered benefit for diagnosing dementia and
neurodegenerative disease, including Alzheimer’s disease.
Previously, amyloid PET scans were only covered by Medicare once in
a beneficiary’s life, and only if they were enrolled in a clinical
trial. The removal of those limitations makes it easier for
Medicare beneficiaries to have coverage for amyloid PET scans if
recommended by their healthcare provider.
3. Early-onset Alzheimer’s disease
While the prevalence of Alzheimer’s disease increases with age,
it is believed about 200,000 young people in the United States –
between the age of 30 and 64 years old – have the disease. Medicare
benefits are available for early onset Alzheimer's disease if a
person has been receiving Social Security disability benefits for a
period of at least 24 months.
4. Care at an assisted living facility or nursing
home
While Medicare does not cover long-term care or the cost of
a memory care facility, it does cover the costs of some care
provided in a facility:
- Medical care: Medicare covers the cost of medical care, as
opposed to custodial care, received by a beneficiary who is living
in a long-term care facility.
- Skilled nursing: Medicare will cover required skilled nursing
facility care for up to 100 days after a dementia patient has an
inpatient hospital stay.
- Hospice: Medicare Part A hospital coverage includes hospice
coverage, with minimal out-of-pocket costs, for beneficiaries who
agree to palliative care when their doctor certifies they are
expected to live no longer than six months.
Medicaid covers nursing home costs for eligible beneficiaries.
Medicaid may cover some assisted living facility costs or memory
care costs for qualified recipients, but benefits vary from state
to state.
5. Home health
As the population ages, demand for home healthcare continues to
grow. Medicare Part A will pay for up to 35 hours of in-home
care per week for dementia patients who are homebound and require
skilled nursing care. Covered care can also include help with
activities of daily living as long as the patient is also receiving
skilled nursing care, or occupational, physical, or speech
therapy.
Additional home health benefits may also be available through
Medicaid or the Medicare-Medicaid Program of All-Inclusive Care for
the Elderly (PACE) for individuals who qualify.
“Medicare doesn’t cover all of the costs patients and families
face for Alzheimer’s disease or dementia, but it covers many of the
fundamental care costs that could otherwise be overwhelming for
beneficiaries,” Norris said. “By understanding your Medicare
benefits, you can make sure you’re not paying out-of-pocket for
care and services you could get covered by Medicare.”
Medicareresources.org has been an online source of in-depth
information about Medicare for consumers since 2011. The site,
owned by Healthinsurance.org, LLC, provides an overview of the
basics of Medicare coverage options, enrollment and
eligibility; coverage FAQs; state-specific Medicare
information; and a glossary of Medicare terms.
Medicareresources.org is not connected with or endorsed by the U.S.
government or the federal Medicare program.
medicareresources.org
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