Medicare And Dementia Care: What It Does And Doesn't Cover

Alzheimer's disease or any kind of dementia permanently alters a person's level of independence and ability to function.

What's more, is that it also affects family members. In many instances, the patient's adult children will assume a caregiving role, demanding significant time, effort, and resources.

Even with Medicare coverage, the typical cost of treating this disease is high.

Each Medicare-related payment for a person with Alzheimer's disease costs about $49,000, while the Alzheimer's Association reports that people who don’t have Alzheimer’s or dementia are charged just about $14,000.

As a caregiver, it is crucial to understand which aspects of care are covered by Medicare and which out-of-pocket payments must be planned for.

This information will enable you to manage the financial responsibilities associated with dementia so that they do not become an additional cause of conflict, anxiety, or unpredictability as the illness of your elderly loved one worsens.

Let us outline two Medicare-covered care areas and two that are not covered.

What Medicare Covers

Here are the things that Medicare covers for seniors with dementia:

Essential Medical Care

Medical necessity is defined by the Centers for Medicare & Medicaid Services (CMS) as “Services or supplies that: are proper and needed for the diagnosis or treatment of your medical condition, are provided for the diagnosis, direct care, and treatment of your medical condition, meet the standards of good medical practice in the local area, and aren't mainly for the convenience of you or your doctor.”

These are typically medical appointments, laboratory testing, necessary procedures, referrals to specialists, and emergency care.

Some Alzheimer's medications are considered a medical necessity under Medicare Part D if they are approved to treat or manage Alzheimer's or dementia symptoms.

Few Rehabilitative Care

Medicare will, to a certain extent, fund home health services, such as physical and occupational therapy, that are required following hospitalization.

According to U.S. News & World Report, Medicare will cover up to 100 days of skilled nursing facility care every benefit period as long as it is considered rehabilitation and not long-term care.

Medicare will also reimburse 35 hours per week for up to 60 days if temporary home health care is required.

What Medicare Doesn’t Cover

Here are the things that Medicare doesn’t cover for seniors with dementia:

Custodial Or Memory Care

Most Alzheimer's and dementia patients require assistance with activities of daily living (ADLs) such as eating, personal hygiene, dressing, and bathing as their symptoms progress.

These services are referred to be custodial care by Medicare, and they are often not covered.

Nevertheless, Investopedia lists two exceptions: “[if] the care is considered medically necessary and prescribed by a licensed physician or authorized medical personnel, and [if] the care is conducted by a healthcare provider who participates in Medicare.”

Long-term Care Facility

In the later stages of Alzheimer's disease or dementia, your elderly loved one may need to relocate to an assisted living facility or nursing home.

This type of care and accommodation is not covered by Medicare. However, Medicare Supplement plans can assist with certain out-of-pocket expenses.

Assisted living costs $48,000 a year on average and is more inexpensive than 24-hour in-home care.

Medicare helps pay for various levels of dementia treatment and care, but it's important to also plan for services that Medicare does not cover.

Planning now for future care expenses can decrease the financial stress and allow you to focus on the physical and emotional health of your elderly loved one.

For more resources about dementia, check out Senior Stong’s Health and Wellness page today.

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William Rivers is an editor with a master’s degree in Human Services Counseling at Maine State University. He has more than 20 years of experience working in the senior healthcare industry.
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