Medicare is a federal health insurance program for Americans age 65 and older and persons with disabilities that covers a wide range of services to keep you healthy as you age.
If you have Alzheimer’s disease, a debilitating disease affecting 6.2 million Americans, Medicare will help pay for your care for medical and mental health conditions.
Learn more about what is and isn't covered for Alzheimer's and find out how you can get help sorting through your Medicare options with a trusted NCOA partner.
Alzheimer’s disease is a brain disorder that some people may get when they are older. It is a form of dementia. It can make people lose their memory, act differently and have trouble thinking and solving problems.
According to the US Food and Drug Administration, more than 6.2 million people in the United States have Alzheimer’s. Alzheimer’s disease patients also may suffer from depression, agitation, anxiety, and other health conditions.
Find out what Medicare covers for Alzheimer’s disease
If you have Alzheimer’s disease, Medicare will help pay for your care for medical and mental health conditions. This may include:
Ongoing hospital care, doctor visits and needed medical items.
This includes care for diagnosis and treatment:
- Diagnosis: Medicare will help pay for the doctor visit, physical exam and several tests used to diagnose Alzheimer’s disease. Medicare will only cover the costs of PET (Positron Emission Tomography) scans in certain cases for Alzheimer’s disease. PET scanning is a medical test that can diagnose Alzheimer’s disease in its early stages.
- Treatment: Medicare also helps pay when you see your doctor to treat and manage Alzheimer’s disease. It will pay if your doctor asks another doctor to see you. Medicare also will pay if your doctor oversees your home health or hospice care.
Mental health services
Sometimes, people with Alzheimer’s disease need mental health services too. Medicare provides mental health benefit that covers sessions psychiatrists, clinical psychologists or social workers. Medicare will cover 80% of the amount it approves for a mental health service. Learn more about mental health coverage.
Medical social services
A social worker can visit you at home to counsel you and help you deal with the social and emotional side of Alzheimer’s disease. Your doctor must order these services.
Your doctor may include orders for certain medical equipment and supplies if you need this equipment to live at home. This includes a walker, wheelchair or oxygen equipment.
All Medicare drug plans must include certain types of prescription drugs used to treat Alzheimer’s disease. Each plan must cover at least 2 drugs in 2 categories that: Raise the levels of brain chemicals to aid memory and judgment, called cholinesterase inhibitors; and help improve memory, attention, reason and language, called memantine.
Find out more about drugs covered by Part D prescription drug plans. Learn about prescription coverage.
Aduhelm, the new Alzheimer's treatment
Biogen said the cost for a maintenance dose of Aduhelm (generic name aducanumab), based on an average patient’s weight, would be $56,000 per year. That’s a list price, not the price paid by patients with insurance. The out-of-pocket cost for patients with health insurance will vary depending on insurance coverage.
For patients on Medicare, the Centers for Medicare and Medicaid Services will decide on possible limitations, such as who is eligible to receive the medication. The medication would be covered under Medicare Part B since it is given by infusion in a doctor’s office or health care clinic. The co-insurance for beneficiaries enrolled in Original Medicare Part B services is 20%; therefore, the out-of-pocket cost for Medicare beneficiaries will be $11,200 per year. For those with Medicare supplemental or other secondary insurance, the costs may be less. For individuals enrolled in Medicare Advantage plans, the out-of-pocket cost will vary but could be as much as 20%.
Medicare does not cover these types of care for Alzheimer’s disease:
- Long-term care: This includes long-term nursing home stays beyond 100 days, the costs of assisted living facilities and adult daycare.
- Personal care also called custodial care: This includes paying another person to help you bathe, dress, fix meals and do other daily activities. People with Alzheimer’s disease often need more and more custodial services as time goes on.
Medicare will cover custodial care, both at home and during a brief stay in a skilled nursing facility, but only when you also need and get skilled care. People with Alzheimer’s disease often need other types of care that Medicare does not cover. Alzheimer’s disease patients and their families often must pay for these services if they do not qualify for Medicaid or long-term care insurance.
Need help thinking through your Medicare options?
If you need help sorting through your options, NCOA has a trusted partner that is committed to serving your Medicare selection needs and priorities at no cost to you. Our process connects you with licensed Medicare enrollment specialists backed by our decades-long commitment to helping older adults thrive. To learn more, connect with an enrollment specialist from Medicare Choice Group today.