Minneapolis, MN – 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.
Contact:
Amy Fletcher Faircloth, [email protected]
Tags: Alzheimer’s disease, dementia, memory care
