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What does Medicare cover for Alzheimer’s disease?
Alzheimer’s disease is a brain disorder that some people may get when they are older. It is a form of dementia. It can make people lose their memory, act differently and have trouble thinking and solving problems.
More than 5 million people in the United States have Alzheimer’s disease. It is the sixth leading cause of death. Alzheimer’s disease patients also may suffer from depression, agitation, anxiety and other health conditions.
Find out what’s covered for Alzheimer’s disease
If you have Alzheimer’s disease, Medicare will help pay for your care for medical and mental health conditions. This may include:
Ongoing hospital care, doctor visits and needed medical items.
This includes care for diagnosis and treatment:
Diagnosis: Medicare will help pay for the doctor visit, physical exam and several tests used to diagnose Alzheimer’s disease. Medicare will only cover the costs of PET (Positron Emission Tomography) scans in certain cases for Alzheimer’s disease. PET scanning is a medical test that can diagnose Alzheimer’s disease in its early stages.
Treatment: Medicare also helps pay when you see your doctor to treat and manage Alzheimer’s disease. It will pay if your doctor asks another doctor to see you. Medicare also will pay if your doctor oversees your home health or hospice care.
Mental health services
Sometimes, people with Alzheimer’s disease need mental health services too. Medicare provides mental health benefit that covers sessions psychiatrists, clinical psychologists or social workers. Medicare will cover 80% of the amount it approves for a mental health service. Learn more about mental health coverage.
Medical social services
A social worker can visit you at home to counsel you and help you deal with the social and emotional side of Alzheimer’s disease. Your doctor must order these services.
Your doctor may include orders for certain medical equipment and supplies if you need this equipment to live at home. This includes a walker, wheelchair or oxygen equipment.
All Medicare drug plans must include certain types of prescription drugs used to treat Alzheimer’s disease. Each plan must cover at least 2 drugs in 2 categories that: Raise the levels of brain chemicals to aid memory and judgment, called cholinesterase inhibitors; and help improve memory, attention, reason and language, called memantine.
Find out more about drugs covered by Part D prescription drug plans. Learn about prescription coverage.
Medicare does not cover these types of care for Alzheimer’s disease:
Long-term care: This includes long-term nursing home stays beyond 100 days, the costs of assisted living facilities and adult daycare.
Personal care also called custodial care: This includes paying another person to help you bathe, dress, fix meals and do other daily activities. People with Alzheimer’s disease often need more and more custodial services as time goes on.
Medicare will cover custodial care, both at home and during a brief stay in a skilled nursing facility, but only when you also need and get skilled care. People with Alzheimer’s disease often need other types of care that Medicare does not cover. Alzheimer’s disease patients and their families often must pay for these services if they do not qualify for Medicaid or long-term care insurance.