Medicare and Alzheimer’s Disease: Your Coverage Explained

Medicare covers all medically necessary services related to the prevention, diagnosis, and treatment of Alzheimer’s disease. Here’s a look at what each part of Medicare covers for Alzheimer’s.

Medicare Part A (hospital insurance)

Medicare Part A covers inpatient services related to Alzheimer’s disease, such as:

• short-term inpatient hospital stays
• therapies and medications needed during inpatient hospital stays
• short-term skilled nursing facility stays
• limited home healthcare services
• hospice care

Medicare Part B (medical insurance)

Medicare Part B covers outpatient care for Alzheimer’s disease, such as:

• screening and diagnostic services
• doctor’s and specialist’s visits
• treatment-related services and care
• outpatient prescription drugs given by a medical professional
• physical, occupational, or speech therapy
• inpatient and outpatient mental health services
• necessary durable medical equipment

Medicare Part C (Medicare Advantage)

Medicare Part C covers all Alzheimer’s disease services included under original Medicare (parts A and B). Some Medicare Advantage plans also cover:

• prescription drugs
• dental, vision, and hearing services
• fitness and wellness services

Coverage of these services, and any other additional healthcare perks, depend on the plan you choose.

Medicare Part D (prescription drug coverage)

Medicare Part D helps cover medications that you take at home to treat Alzheimer’s disease.

Every Medicare Part D plan must cover certain protected drug classes, such as antidepressants and antiretrovirals. However, coverage of additional drugs varies based on your drug plan’s formulary, or list of covered drugs.

Medicare supplemental insurance (Medigap)

Medigap helps cover some of the out-of-pocket costs charged by your original Medicare plan. This may include:

• deductibles
• copays
• coinsurance
• other healthcare costs

Unlike Medicare Part D, Medigap plans don’t offer any additional healthcare coverage.

Next, we’ll discuss each of the specific Alzheimer-related services and treatments that Medicare covers.

Doctor’s visits and testing

Alzheimer’s disease, like most forms of dementia, benefits from early diagnosis and treatment. Medicare covers both preventative and diagnostic services for Alzheimer’s disease, starting with yearly wellness visits and cognitive impairment assessments.

Medicare also covers:

• diagnostic non-laboratory tests
• diagnostic laboratory tests
• yearly depression screenings

These diagnostic tests and screenings can help detect early signs of Alzheimer’s disease and rule out any other underlying causes of cognitive decline. They can also be used to monitor Alzheimer’s disease progression once you know you have it.

Medicare Part B will cover any medically necessary services related to screening, diagnosing, and monitoring Alzheimer’s disease.

Medications

Currently, two prescription medications are FDA-approved to treat the cognitive symptoms of Alzheimer’s disease: cholinesterase inhibitors and memantine.

Cholinesterase inhibitors are used to slow cognitive decline by increasing the levels of acetylcholine (a type of neurotransmitter) in the brain.

Memantine is often prescribed with cholinesterase inhibitors to further decrease cognitive decline.

Both medications, when used together, may help decrease both cognitive and behavioral symptoms of Alzheimer’s disease.

Medicare Part D will cover most of the prescription drugs used to treat the symptoms of Alzheimer’s disease, as long as the drugs are included in your plan’s formulary.

Services and therapies

People who have been diagnosed with Alzheimer’s disease may experience both cognitive and behavioral changes, some of which may be benefited by:

• physical therapy
• speech-language pathology services
• occupational therapy
• mental health services

Physical therapy is helpful for addressing the physical limitations that Alzheimer’s disease might cause, while speech therapy can help with your ability to communicate.

Occupational therapy and mental health services can improve overall quality of life, both physically and mentally.

Medicare Part B will cover any medically necessary services related to improving the symptoms of Alzheimer’s disease.

Durable medical equipment

In the later stages, Alzheimer’s can have a negative impact on mobility.

Over time, it may cause difficulty walking or moving around, and durable medical devices might be helpful. These might include:

• canes
• crutches
• lifts
• walkers
• wheelchairs

Medicare Part B will cover medically necessary durable medical equipment that you use at home.

Alzheimer’s coverage at a glance

Here’s a quick overview of some of the Medicare-covered items, services, and medications that may be necessary for Alzheimer’s care:

While Medicare covers a wide range of inpatient and outpatient services for Alzheimer’s disease, a service might not be covered in certain situations, including:

• Nursing home care. Medicare will not cover nursing home care if it’s the only care you require for Alzheimer’s disease. If you require around-the-clock custodial care, you will pay the full out-of-pocket cost.
• Off-label medications. Medicare covers certain medications only when they’re prescribed for an FDA-approved use. If your doctor decides to use a medication that isn’t yet approved for Alzheimer’s symptoms, your prescription drug plan may not cover it.
• Skilled nursing facility care. Medicare covers short-term nursing facility care, which generally includes many of the services, medications, and other needs you would have in an outpatient setting. However, you’ll only be covered for up to 20 days at no cost. After that, you’ll owe a portion of the costs as coinsurance each day.

If you’re concerned that your plan won’t cover a service or medication, you can reach out to your doctor or insurance provider to check.

Alzheimer’s disease is a type of dementia that causes progressive cognitive decline. It primarily affects people over age 65 and accounts for roughly 60 percent to 80 percent of dementia cases, according to the Alzheimer’s Association.

Early symptoms of Alzheimer’s disease may include:

• inability to remember new information
• disorientation
• poor judgement
• memory loss
• mood changes
• behavioral changes
• increased paranoia

If you or someone you love is experiencing the early symptoms of Alzheimer’s disease, schedule a wellness visit with a healthcare provider for diagnostic testing.

As Alzheimer’s disease progresses, it can cause more severe cognitive and behavioral changes, including trouble speaking, drinking, eating, and even walking.

Eventually, people with Alzheimer’s will require around-the-clock care. However, early diagnosis and treatment may help delay progression of the disease and increase quality of life.

Alzheimer’s disease affects millions of Americans each year, many of whom are enrolled in Medicare. Fortunately, Medicare coverage for Alzheimer’s disease is fairly comprehensive, covering everything from diagnostic testing to FDA-approved medications, and more.

However, not all services for Alzheimer’s disease are included under Medicare, so check with your plan provider if you’re not sure whether something is covered.