What exactly does Medicare cover for Alzheimer’s disease? My husband was recently diagnosed with early Alzheimer’s disease. We want to know what is covered and what is not.
Plan in advance
Dear plan,
We apologize for the diagnosis of your husband, but we would appreciate it if you could know that Medicare bears most of the medical costs for treating the beneficiaries of Alzheimer’s disease. Unfortunately, the long-term administrative costs that most patients ultimately need are not. Here’s a breakdown of what Medicare does and doesn’t cover about Alzheimer’s disease, and some tips to help you plan ahead.
Medical: In most cases, ongoing medical care to diagnose and treat Alzheimer’s disease is covered by Medicare Apartment B, which includes primary care and specialist visits, lab tests, speech and occupational therapy, home care, and outpatient counseling services. Will be done. Medicare pays 80% of these costs, and after you meet the $ 233 annual Part B deduction, you will be responsible for the remaining 20%.
After paying a $ 1,556 deduction, 60 days of inpatient treatment is also eligible for Medicare Apartment A. After 60 days, daily communal premiums will be added.
Medications: Most Alzheimer’s disease medications are covered by Medicare’s Part D prescription medication plan, but the scope varies, so check his plan’s prescription. The only exception is Aduhelm, a controversial new drug that is estimated to cost $ 28,200 a year. Medicare Apartment B will only cover this drug if your husband is enrolled in a clinical trial.
Long-term management care: It is important to understand that the original Medicare does not cover long-term management care. This includes nursing home care, living support facility costs, and adult day care. However, Medicare will cover the cost of short-term nursing home care, but within 100 days of hospitalization for 3 days.
Hiring home care for bathing, toileting, and changing clothes (this is known as management care) is subject to Medicare unless your husband also has skilled nursing care or physiotherapy or occupational therapy. Must not be.
To support these costs, we recommend that you consider getting long-term care insurance or a short-term care plan (see aaltci.org/stc) if possible. Or, if your income and assets are very limited, you can qualify. For Medicaid. Visit PayingForSeniorCare.com to explore financial options for long-term care.
Hospice: In the final stages of illness, Medike Apartment A covers almost all aspects of hospice care, including physician services, long-term care, drugs, medical equipment and equipment, physiotherapy and occupational therapy, housewife services, counseling and respice care. increase. To qualify, the doctor must prove that the patient has a survival time of 6 months or less.
Other insurance and support
If your husband has the original Medicare and is not covered by Medigap, you should consider insuring your husband. The Medigap plan helps you pay for things that are not covered by Medicare, such as out-of-pocket expenses, joint insurance, and deductions. To find a plan for your area, go to Medicare.gov / plan-compare and click “Medigap Policy Only”.
Or, if you are enrolled in a Medicare Advantage plan (such as an HMO or PPO), his plan must offer at least the same coverage as the original Medicare. Some advantage plans may also offer additional compensation for home care services.
If you can’t afford Medicare’s out-of-pocket costs, or if you need help with medication costs, there are Medicare Savings and Additional Help programs that provide financial support for medication. See Medicare.gov / your-medicare-costs / get-help-paying-costs for more information.
You can also get help through a state health insurance support program that offers free Medicare and long-term care counseling (see ShipHelp.org or call 877-839-2675).
For senior questions, please send to Savvy Senior, PO Box 5443, Norman, OK 73070 or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today Show and author of “The Savvy Senior”.
