Medicare takes up arms against memory loss

The difficult truth about Alzheimer’s disease and other forms of dementia is that currently there is no full-fledged cure available. However, with early detection and appropriate treatment, its symptoms can be managed and even slowed down.

Smiling grandmother playing cards with family

Cognitive diseases such as Alzheimer’s and other forms of dementia aren’t fully understood globally, and a lot of research is ongoing in the field. While people typically take precautions to improve their physical well-being as they get older and reach their golden years, mental health is not something that is always focused on (despite the growing number of people in therapy and counseling). It is at times treated as something that can be ignored until intervention becomes inevitable.

However, this lack of awareness and focus on prevention could prove to be risky, considering just how common mental health diseases are becoming. It’s widely known that cognitive diseases like Alzheimer’s tend to surface largely in the later stages of adult life, typically once we have passed the threshold of becoming senior citizens. The Alzheimer's Association shares some startling statistics on Alzheimer’s and dementia in the United States: 

  • In the United States, Alzheimer's is the 6th leading cause of death.
  • 1 in 3 seniors dies with Alzheimer’s or another type of dementia. It kills more than breast cancer and prostate cancer combined.
  • 5.8 million Americans are living with Alzheimer’s. By 2050, it is projected to increase to nearly 14 million.
  • Only 16% of seniors receive regular cognitive assessments during routine health check-ups.

The difficult truth about Alzheimer’s disease and other forms of dementia is that currently there is no full-fledged cure available. However, with early detection and appropriate treatment, its symptoms can be managed and even slowed down.

Dementia and Medicare

Since dementia is a condition that typically affects seniors, the next step is to address the big question – does Medicare cover dementia care? The answer is, there is Medicare coverage for dementia patients, however, this coverage isn’t all-encompassing. Here’s a breakdown of what is and isn’t part of Medicare coverage for dementia.

Diagnosis and treatment

A majority of your medical costs associated with diagnosis and treatment of dementia are covered in your Medicare Part B plan. This includes:

  • Primary care from doctors and specialists
  • Laboratory testing
  • Speech and occupational therapy
  • Home health care
  • Outpatient counseling

In a standard Original Medicare plan, once you have reached your annual deductible amount, Medicare will cover 80% of all costs related to the above treatments and medical services, with you needing to foot the bill for the remaining 20% of the treatment. Inpatient hospital care is also covered through Medicare under Part A and will incur deductibles and coinsurance charges as well. However, Medicare will cover the cost for an annual wellness visit, which will include tests for cognitive diseases.

Medication and drugs

If you are enrolled in a Medicare Part D drug coverage plan, then medication and drugs for Alzheimer’s will typically be covered as part of this plan as well. Check your individual plan to ensure that medication pertaining to cognitive diseases are covered, and remember that what you pay in terms of copayments will change according to the type of plan you have opted for.

Long-term medical care

There is currently no comprehensive long-term medical care program in Medicare for those suffering from mental health issues. Medicare offers coverage for up to 100 days in a skilled nursing home based on specific circumstances, and may not cover the complete cost. It’s important to take a close look at your individual plan to better understand what will be covered in this circumstance.

Hospice care

As part of Medicare Part A, you do receive hospice care as long as your doctor certifies that you are in the final stages of the disease and are expected to live six months or less. In this situation, Medicare covers a wide variety of hospice care related costs. This includes:

  • Doctor’s services
  • Nursing care
  • Prescription drugs
  • Medical equipment and supplies
  • Physical and occupational therapy
  • Homemaker services
  • Counseling
  • Respite care

While Medicare provides a certain amount of care for dementia patients, the coverage doesn’t provide relief for each and every cost that a dementia patient could incur. This is especially true if you opt only for Original Medicare coverage. An alternative and potentially more comprehensive option could be a Medicare Advantage plan offered by Blue Shield of California. These plans have to offer at least all the coverage that Original Medicare offers, and usually surpass this coverage as well. If you are susceptible to mental health issues or want to make sure that you are well covered, it’s important to explore your Medicare options and choose a plan that offers the most comprehensive coverage for care related to dementia.

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Page last updated 10/12/2023

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