Does Medicare cover Dementia?

Dementia is a term describing a group of symptoms that can include impaired reasoning, memory, and personality changes. Alzheimer’s makes up an estimated 50-70 % of dementia cases, but other conditions can also cause dementia. Among these are Huntington’s Disease, Parkinson’s Disease, Creutzfelt-Jakob disease, infections, cancer, and vascular disease. Since there is no single definitive test for the source of dementia, diagnosis can be expensive. After diagnosis, getting the proper care for a dementia patient can cost even more. Luckily, Medicare can help with these costs.

Diagnosing the source of dementia can be a lengthy process, involving mental evaluations, blood tests, and teams of specialists. It’s not unusual to see neurologists, psychologists, psychiatrists, and genetic counselors in the effort to pinpoint your underlying condition. Even then, diagnoses such as Alzheimer’s may not be 100% accurate. Someone can even have “mixed dementia,” where multiple conditions contribute to dementia symptoms. Medicare Part B covers diagnostic processes, so once you reach your $166 deductible Medicare will pay for 80% of the cost of your outpatient evaluations.

After diagnosis, Medicare can also help cover the cost of treatment. Some cases of dementia can respond to treatment, such as cases caused by drugs or hypoglycemia. But for the vast majority of people suffering from dementia, their condition cannot be cured. Medicare gives you a few options for managing dementia symptoms.

If you have Medicare Parts A and B, inpatient and outpatient treatments for dementia will usually be covered–provided you pay your deductibles, premiums, and copays. These treatments can include psychological counseling for mood disorders associated with dementia. It can also include physical and occupational therapy. Most standard medication for managing dementia is covered under Medicare Part D.

Dementia patients usually benefit from long-term custodial care to get help dressing, eating, and bathing. Unfortunately, Medicare only covers short-term stays at nursing homes and skilled nursing facilities. Please see our article on nursing home coverage for a more detailed explanation.

Special Needs Plans

It may be appropriate to consider taking a Special Needs Plan (SNP) from Medicare. SNPs are a type of Medicare Advantage plan streamlined to serve people with specific medical conditions and disabilities, like dementia. They cover everything in Parts A, B, and D in Medicare. So in addition to hospital and outpatient insurance, prescription drug coverage is part of the package. You may also get extra services covered, like additional hospital days or skilled nursing days.

An SNP for dementia may not be available where you live. In 2012, SNPs for dementia were restricted to a few dozen counties in Florida and Minnesota. However, the availability of SNPs has expanded in recent years. To find Medicare SNPs in your area, visit medicare.gov and search your location on the Medicare Plan Finder.

Hospice care is another Medicare-covered option for those with terminal conditions, like late stage Alzheimer’s. To qualify, a doctor must certify that the patient is expected to live for less than six months. For more information on Medicare’s coverage of hospice, please visit our article.

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