The financial burden of dementia might seem overwhelming, but Medicare and Medicare Supplement Insurance can help. While primarily thought of for medical care, some of the personal care required for loved ones with Alzheimer’s disease and related dementias is covered by Medicare in its various forms described below. Alzheimer’s disease, vascular dementia, frontotemporal dementia (FTD or Pick’s disease), and Lewy body dementia are all progressive illnesses, meaning they change from stage to stage. Care needs change as well, and Medicare benefits can be targeted to help pay for particular needs.
This article will explain Medicare and Supplement Insurance benefits as they relate to the progression of these dementias through early, middle and late stages. Lastly, we will look at a new initiative that is being considered that would expand benefits for traditional Medicare enrollees with Alzheimer’s.
During the early stages of dementia, symptoms vary based on the type of dementia because different parts of the brain are affected. However, both Alzheimer’s disease and vascular dementia present similarly, and it can be difficult to discern which dementia an individual has. That said, Alzheimer’s patients tend to have more difficulty with memory. Examples include difficulty finding the right word for an object, forgetting the name of someone they just met, or misplacing items such as car or house keys.
With vascular dementia, early symptoms include difficulty making decisions, issues with organization, delayed thought process, and lack of focus. It’s also important to note that vascular dementia may have a sudden onset or may progress gradually.
The symptoms of Lewy body dementia may fluctuate from day to day, so alertness and attention span can appear very good one day and function poorly the next. One may also experience visual and auditory hallucinations, lose inhibitions, show a lack of interest in other people or activities, lose the ability to show sympathy and empathy, and overeat.
As with Lewy body dementia, an individual with frontotemporal dementia may present with behavior that is disinhibited, and may appear uncaring. They may also present with obsessive-compulsive behavior and be more easily distracted.
In the early stages of these four dementias, individuals are generally able to function rather independently and require little assistance.
Annual Wellness Visit / Health Risk Assessment – It is important that dementia is accurately diagnosed to develop an appropriate Care Plan, which is essential as one prepares for the middle and late stages of dementia. Medicare will cover the cost of an annual wellness visit and health risk assessment, which includes questions about an individual’s health and can be used as a starting point of diagnosis. Medicare will also cover the cost of a cognitive assessment, as well as care planning services with a medical professional. There are no fees associated with this annual wellness exam.
Diagnostic Testing – Medicare will cover the cost of diagnostic testing if requested by a physician. This may include CT scans, MRIs, and PET scans that allow doctors to see brain abnormalities from blood vessel diseases, strokes, and trauma that could cause changes in cognition. PET scans also allow doctors to see if brain activity has increased or decreased. The co-payment for non-laboratory tests is 20% of the amount approved by Medicare.
Mental Health Services – It is common for individuals in the early stage of dementia to present with anxiety or depression. In fact, early dementia is sometimes misdiagnosed as depression. Medicare offers an annual depression screening free of charge. Mental health services, such as inpatient psychiatric care, outpatient counseling, psychiatric evaluations, and medication management, are also available. Copayments for these services vary.
Prescription Drugs – With Medicare Part B, prescription drugs are not covered to help manage the symptoms of dementia. However, an individual with Medicare Part D may be able to have certain prescription drugs covered. There may be co-payments, some medications may need prior approval, and quantity limits might apply. These medications do not cure dementia but they can help decrease symptoms like confusion and memory loss for those with Alzheimer’s and vascular dementia. With Alzheimer’s, Lewy body dementia, and vascular dementia, medication to treat hallucinations may also be helpful. With all the dementias, medications may be beneficial if depression or anxiety is present.
Alternative Therapies – Some people in the early stages of dementia prefer alternative therapies. Unfortunately, Medicare does not cover the cost treatments including acupuncture, nutritional supplements, vitamins, and herbal remedies.
During middle-stage dementia, there is a greater need for care. In most cases, an individual in the middle stage of dementia should not be left unsupervised.
As the disease progresses, vascular dementia presents more similarly to Alzheimer’s. With both dementias, an individual in the middle stage will exhibit a greater level of confusion and have more difficulty communicating. They likely will require assistance with everyday tasks like cooking, getting dressed, and taking a bath. One might also present with a variety of mood shifts such as frustration, anger, and aggression. Hallucinations are also possible.
As with Alzheimer’s disease and vascular dementia, cognition declines in individuals with Lewy body and frontotemporal dementia. With Lewy body dementia, one may show confusion and a shorter attention span, while with frontotemporal dementia, one may present with severe issues with attention, planning, and memory. Those with Lewy body dementia also will experience more difficulty with movement, speech, and may exhibit paranoid behavior. With frontotemporal dementia, compulsive behaviors include hoarding, making repetitive movements, and binge eating.
Caregiver Training for Family Members – In 16 states, Medicare offers caregiver training by home health nurses for families or caregivers of those with dementia. This training covers topics including how to handle behavioral symptoms. The states offering training are Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas. The training is centered on the needs of the family, including handling difficult behavior such as getting distracted during meals and not cooperating with everyday tasks like bathing.
Home Health Services – Medicare will cover home health services by a skilled professional if a dementia patient fits the following conditions:
– is not able to leave his or her home
– requires speech, occupational, and / or physical therapy
– requires intermittent nursing care
– a physician deems the services necessary
This also holds true for durable medical equipment and supplies. While Medicare generally doesn’t cover the cost of home health aides, it may help to cover the cost in the situation described above. This can include personal assistance and medication management.
Other services that are usually needed in the middle stages include homemaking and meal delivery, because cleaning and cooking become much more difficult. These are not offered under traditional Medicare, but enrollees in Medicare Advantage (Medicare Part C) may be eligible for these, as well as transportation to doctor appointments. More on Medicare Advantage.
Assisted Living / Adult Day Care – Unfortunately, traditional Medicare will not cover the cost of assisted living, memory care, or adult day care, although it is common that dementia patients at this stage require these types of care. A program called PACE (Program of All-Inclusive Care for the Elderly), however, combines Medicare and Medicaid and is designed to provide services that keep someone in need of nursing-home level care from actually moving into a nursing home. Adult day care is among the benefits included, and people with dementia may be eligible. For more information on PACE, including eligibility requirements, click here.
By the late stages of every type of dementia, individuals will require extensive care around the clock, including personal care assistance. Unfortunately, family caregivers often can no longer provide the care needed. An individual who has Alzheimer’s disease will have at least some of the following issues:
– profound memory loss
– difficulty verbally communicating
– needs help walking or can’t walk at all
– angry / aggressive outbursts
– difficulty eating and swallowing
As mentioned previously, the symptoms of vascular dementia present very similarly to Alzheimer’s as one progresses through the stages of the disease. Pronounced memory loss, disorientation, difficulty communicating, and agitation may all be seen in individuals with vascular dementia.
Those with Lewy body dementia will also present with some of the symptoms of Alzheimer’s, such as memory issues and outbursts of anger / aggression. However, there are also Parkinson’s disease-like symptoms including extreme muscle stiffness and sensitivity to touch.
As with the other types of dementia, frontotemporal dementia also presents symptoms like Alzheimer’s, such as difficulty walking, swallowing, and controlling bowels and bladder.
Nursing Home Care – While those with late-stage dementia frequently require nursing home care, traditional Medicare unfortunately will not cover those costs. An exception is if skilled nursing and therapy care is required after an admission in a hospital, and even then, Medicare will only cover 80% of the cost of skilled nursing care for a maximum of 100 days.
Another exception is the Program for All-Inclusive Care for the Elderly (PACE), which combines Medicaid and Medicare for people eligible for both those programs. PACE is designed for people in need of nursing-home level care, and enrollees can work with their provider to see if actual nursing home care (which is among the program’s listed benefits) can be covered.
Hospice Care – Hospice care may be needed at the end stage of dementia, and is covered by Medicaid Part A. However, a physician must determine that a person has a maximum of six months to live. Hospice care, which can be in one’s home or in an inpatient facility, covers a large variety of benefits including durable medical equipment, nursing care, prescription drugs, respite care, homemaker services, grief counseling, and more.
In April 2021, a new Bill was introduced into the US Senate called the Comprehensive Care for Alzheimer’s Act. This Act, should it pass and become a law, will expand Medicare’s benefits for persons with Alzheimer’s disease and other related dementias. It is hoped that costs to both patients and Medicare will go down while an improvement to the patient’s quality of life will go up.
The Comprehensive Care for Alzheimer’s Act will provide individual care plans for patients and their caregivers. It will “include medication management, coordination of care, and health, financial and environmental monitoring.”
Current Medicare benefits do not cover many of the costs associated with Alzheimer’s and dementia. Medicare Plans A and B generally includes 100 days in a nursing home, 35 hours a week for home health care (for persons who are homebound), regular visits to the doctor and hospitalizations. The Comprehensive Care Act would eliminate out of pocket spending for therapies, copays, and deductibles. Patients would be responsible only for their premiums. The changes will also include training and support for paid and unpaid (family) caregivers.
At this time, the Comprehensive Care for Alzheimer’s Act has not been passed or signed into law. There is no projected timeline for when this Bill could be voted on and signed into law.