The Norman Transcript

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December 23, 2013

How Medicare covers Alzheimer’s disease

NORMAN — Dear Savvy Senior, What all does Medicare cover when it comes to Alzheimer’s disease? My wife was recently diagnosed with early stage Alzheimer’s and I would like to find out what’s covered and what’s not.

Researching Spouse

Dear Spouse,

Most medical costs to treat beneficiaries with Alzheimer’s disease are covered by Medicare, but unfortunately long-term custodial care costs that most patients eventually need are not. Here’s a breakdown of what Medicare does and doesn’t cover when it comes to Alzheimer’s disease, along with some tips that can help you plan ahead.

Medical care: For the most part, ongoing medical care to diagnose and treat Alzheimer’s disease is covered by Medicare Part B, including visits to primary care doctors and specialists, lab tests, speech and occupational therapy, home health care and outpatient counseling services. Medicare pays 80 percent of these costs, and you will be responsible for the remaining 20 percent after you’ve met your annual $147 Part B deductible.

Inpatient hospital care also is covered under Medicare Part A with a $1,216 deductible and coinsurance. And, as part of health care reform, Medicare is also covering 100 percent of annual wellness visits, which includes testing for cognitive impairment.

Medications: Most Alzheimer’s medications are covered under Medicare’s Part D prescription drug plans, but plans vary on copayments. If you have a Part D plan, use the Medicare Plan Finder tool at medicare.gov/find-a-plan to compare your plan’s total drug costs against other plans to be sure you’re getting the best coverage. The Alzheimer’s Association offers a chart on coverage for common Alzheimer’s drugs – go to alz.org and type “drug chart” in the search field to find it.

Long-term custodial care: Many seniors are surprised to learn that Medicare does not cover long-term custodial care. This includes nursing home care, the costs of assisted living facilities and adult day care. Medicare does, however, pay for some shorter-term nursing home care, but only up to 100 days following a three-day inpatient hospital stay.

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