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Medicare Coverage for Alzheimer’s Disease

What exactly does Medicare cover when it comes to Alzheimer’s disease?

Most of the medical costs for treating Alzheimer’s sufferers are covered by Medicare. Unfortunately, the long-term 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, continuing medical care to diagnose and treat Alzheimer’s disease is covered by Medicare Part B, including visits to primary care physicians and specialists, laboratory tests, occupational and speech therapy, care home medicine and outpatient counseling services. Medicare pays 80 percent of those costs and you will be responsible for the remaining 20 percent after you meet your $ 233 annual Part B deductible.

Sixty days of inpatient hospital care are also covered by Medicare Part A after paying a $ 1,556 deductible. Beyond 60 days, a daily co-insurance fee is added.

Medications: Most Alzheimer’s drugs are covered by Medicare Part D prescription drug plans, but coverage varies, so see your plan form. The only exception is Aduhelm, the controversial new drug that is estimated to cost $ 28,200 a year. Medicare Part B will only cover this drug if your husband is enrolled in a clinical trial.

Long-term custody: It is important to understand that original Medicare does not cover long-term care. This includes nursing home care, assisted living facility costs, and adult day care. However, Medicare pays for care in a nursing home in the short term, but only up to 100 days after a three-day hospital stay.

Hiring home help for bathing, bathing, and dressing (this is known as babysitting care) is also not covered by Medicare, unless your husband is also receiving specialized nursing or physical therapy care. the occupational.

To help with these costs, you may want to look for a long-term care insurance policy or a short-term care plan if possible, or if your income and assets are very limited, you may qualify for Medicaid. To research your financial options for long-term care, go to PayingForSeniorCare.com.

Hospices: In the final stages of illness, Medicare Part A covers almost every aspect of hospital care, including medical services, nursing care, medications, medical equipment and supplies, physical and occupational therapy. housewife services, counseling and respite care. To qualify, a physician must certify that a patient is six months or younger.

Other Insurance and Assistance

If your husband is enrolled in the original Medicare and does not have a supplemental insurance policy, also called Medigap, you should consider getting one. A Medigap plan will help pay for things that are not covered by Medicare, such as copayments, coinsurance, and deductibles. To search for plans in 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), your plan must provide you with at least the same coverage as the original Medicare. Some benefit plans may also offer additional coverage for home care services.

If you are unable to pay your Medicare out-of-pocket costs or need help with your drug costs, there are Medicare savings programs and the supplemental help program that offer financial assistance for your medications. For more information, see Medicare.gov/your-medicare-costs/get-help-paying-costs.

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