Medicare and Supplemental Insurance Benefits for Alzheimer’s Disease & Other Dementias

Last Updated: September 10, 2018

Article Overview

As one progresses through the stages of Alzheimer’s Disease, Frontotemporal Dementia (FTD or Pick’s Disease), Vascular Dementia, or Lewy Body Dementia (LBD), Medical care, personal care and other assistance is required. All four of these dementias are progressive in nature and the type of care and assistance required vary based on the stage of the disease. This article will explain Medicare’s benefits as they relate to the progression of these dementias through early, middle and late-stages.


Early Stage Dementia

Behavior & Care Needs

During the early stage of these four types of dementia, the symptoms presented tend to vary based on the type of dementia one has. This is because different parts of the brain are initially affected. However, both Alzheimer’s Disease and Vascular Dementia present similarly, and it can be difficult to discern which dementia an individual has. That being said, both present with cognitive impairments, but Alzheimer’s patients tend to have more difficulty with their memory. Examples include not being able to come up with the correct word for an object, difficulty remembering the name of someone they just met, or misplacing items, such as their car or house keys. With Vascular Dementia, an individual in the early stage generally presents with difficulty making decisions, issues with organization, delayed thought process, and difficulty concentrating. It’s important to note that Vascular Dementia may have a sudden onset or may progress gradually. With Lewy Body Syndrome, the symptoms of the disease may fluctuate from day to day. For instance, an individual’s level of alertness and ability to pay attention may appear very good one day, and the next, he or she may function poorly. One may also experience visual and auditory hallucinations, may be disinhibited, show a lack of interest in others and activities, may have an inability to show sympathy and empathy, as well as overeat. As with Lewy Body Dementia, an individual with Frontotemportal Dementia may present with behavior that is disinhibited, as well as may appear uncaring. They may also present with obsessive-compulsive behavior and be more easily distracted. All in all, in the early stages of these four dementias, individuals are generally able to function rather independently and require little assistance.

Medicare’s Benefits for Early Stage Dementia

Prior to discussing Medicare’s specific benefits, the difference between Medicare and Medicare Supplemental Insurance (Medigap) should be noted. Medicare Supplement Insurance is available via private insurance companies and can greatly benefit those with dementia. It helps to cover part of the cost for services which Medicare covers. Typically, Medicare will cover 80% of the cost and if one has a Supplemental Insurance policy, that policy will cover the remaining 20%. For instance, Supplemental Insurance will help cover Medicare deductibles and copayments. If your loved one does not already have supplemental insurance, it should be considered during this early stage of dementia.

Annual Wellness Visit / Health Risk Assessment – It is important that dementia is accurately diagnosed to develop an appropriate Care Plan. A Care Plan 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 staring point of diagnosis. As of 2018, Medicare will also cover the cost of a cognitive assessment, as well as care planning services with a medical professional for those with dementias. There are no fees associated with this annual wellness exam.

Diagnostic Testing – Medicare will cover the cost of diagnostic testing if requested by an individual’s physician. This may include CT scans, MRIs, and PET scans. This can be particularly helpful since these images of the brain allow doctors to see abnormalities resulting 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. As of 2018, the co-payment for non-laboratory tests is 20% of the amount that is 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, some types of dementia might be misdiagnosed as depression. Medicare offers an annual depression screening, which is 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 for outpatient use. However, an individual with Medicare Part D may be able to have certain prescription drugs covered. While these medications may be covered, there may be co-payments, some medications may need prior approval, and some may have quantity limits. It’s important to note, these medications do not cure dementia. However, for a period of time they may help to decrease symptoms, like confusion and memory loss for those with Alzheimer’s Disease and Vascular Dementia. With Alzheimer’s, Lewy Body Syndrome, and Vascular Dementia, medication to treat hallucinations may also be helpful. With all the dementias, if depression or anxiety is present, medications may be beneficial.

Alternative Therapies – Some people in the early stages of dementia prefer to turn to alternative therapies. Unfortunately, Medicare does not cover the cost of this type of treatment, including acupuncture, nutritional supplements, vitamins, and herbal remedies.

 Did You Know? While Medicare’s benefits for dementia care are limited, there exist a wide variety of other programs that offer assistance. Learn more.


Middle Stage Dementia

Behavior & Care Needs

During middle stage dementia, there is a greater need of care. In fact, 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 and expressing oneself. They likely will require some assistance with everyday tasks, such as cooking, getting dressed, and taking a bath. One might also present with a variety of mood shifts, such as frustration, anger, and aggression, as well as possibly have hallucinations. As with Alzheimer’s Disease and Vascular Dementia, cognition declines in individuals with Lewy Body Syndrome and Frontotemporal Dementia. With Lewy Body Syndrome, 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 Syndrome also will experience more difficulty with movement, speech, and may exhibit paranoid behavior. With Frontotemporal Dementia, compulsive behavior continues, such as hoarding, making repetitive movements, and binge eating.

Medicare’s Benefits for Middle Stage Dementia

Caregiver Training for Family Members – Medicare offers caregiver training, including how to handle behavioral symptoms, by home health nurses for families or caregivers of those with dementia in 16 states. These states include Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas. The training is centered based on the needs of the family and handling behavior that is posing difficulty, such as an individual with dementia coming across as uncooperative or not staying seated during meals.

Home Health Services – Medicare will cover home health services by a skilled professional if a dementia patient is not able to leave his or her home, requires speech, occupational, and / or physical therapy, or intermittent nursing care, and 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, in the situation described above, it may help to cover the cost. This may include personal assistance and medication management. Please note, meal delivery, in-home 24-hour care, and homemaker services are not covered under Medicare even though these may be needed by persons with middle-stage dementia.

Assisted Living / Adult Day Care – Unfortunately, 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 this type of care. For persons residing in assisted living, Medicare will continue to cover their medical costs, but not their personal care and supervision needs or room and board.


Late Stage Dementia

Behavior & Care Needs

By late stage dementia, individuals regardless of the type of dementia, will require extensive care around the clock, including personal care assistance. Unfortunately, family caregivers often can no longer provide the care that is needed. An individual who has Alzheimer’s Disease will have profound memory loss, may no longer be able to verbally communicate, either will need help walking or can’t walk at all, may be incontinent, may have angry / aggressive outbursts, and may have issues with 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 Syndrome 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 seen, such as extreme muscle stiffness and sensitivity to touch. As with the other types of dementia, Frontotemporal Dementia also presents with symptoms like Alzheimer’s, such as difficulty walking, swallowing, and controlling bowels and bladder.

Medicare’s Benefits for Late Stage Dementia

Nursing Home Care – While those with late stage dementia frequently require nursing home care, Medicare unfortunately will not cover the cost of it. The only exception is if skilled nursing and therapy care is required after an admission in a hospital. Even so, Medicare will only cover skilled care nursing facility care for a maximum of 100 days and only 80% of the cost.

Hospice Care – At the end stage of dementia, hospice care may be needed, which is covered by Medicaid Part A. However, one must be determined by a physician to have a minimum of six months to live. The benefit to hospice care, which can be in one’s home or in an inpatient facility, is that this type of care covers a large variety of benefits. This may include durable medical equipment, nursing care, prescription drugs, respite care, homemaker services, grief counseling, and more.