Dear Matt!
My Dad hasn’t seemed like himself for the past few months. Last week we got the diagnosis and it was what we feared–Alzheimer’s. He is 72 and on Social Security and Medicare. What coverage does Medicare offer for Alzheimer’s treatments?
Brad
Hi Brad,
I’m sorry about your Dad’s condition. It sounds like it was something you expected, but getting that definite diagnosis can still be a blow to the family. Now that you know what you’re dealing with, you can make concrete plans to manage it. Investigating his Medicare coverage is a good starting point. There are some recent developments in covered drugs for Alzheimer’s you’ll be glad to know about.
What Does Medicare Cover?
First, let’s review in general the kinds of things Medicare covers. It pays for inpatient hospitalization and some doctor’s fees and necessary durable medical equipment. Medicare pays for up to 100 days of care in a nursing home in some circumstances but does not cover long-term nursing home care.
If a person is nearing the end of their life, Medicare will pay for hospice care in their home, a nursing home, or an inpatient hospice facility. Medicare Part D will cover many necessary prescription drugs.
Health, Wellness, and Cognitive Assessments
Medicare also covers certain kinds of medical assessments. It covers an annual wellness visit, which includes completing a health risk assessment. This is the point at which symptoms of Alzheimer’s might be recognized. For people recently diagnosed with Alzheimer’s or other forms of dementia, Medicare will cover the expense of care planning. This is when the patient and caregivers can be informed about different options for treatment, clinical trials, and community services.
Medicare Advantage
Medicare Part C, also known as Medicare Advantage, widens your options to receive treatment through an HMO, PPO, or point-of-service plan. Some of these are Special Needs Plans specifically designed for people with dementia disorders. You can learn more at Medicare Advantage Plans and at Medicare SNPs, both at medicare.gov.
New Alzheimer’s Drug Coverage
Now this is hot off the press. Just a few days ago we received news about an expansion of Medicare Part B drug coverage to include a new class of Alzheimer’s drugs as soon as they get FDA approval. Two drugs, Leqembi and Aduhelm, are on the fast track for approval.
Leqembi is likely to be the first that becomes available, maybe as soon as July 2023. The Veterans Health Administration has announced they will cover Leqembi for veterans over 65 who meet eligibility requirements.
Note that using these drugs may come with a requirement to register as part of a clinical trial. This has been a controversial requirement that Congress and Alzheimer’s advocates have been trying to get removed as they think it is unnecessary red tape that will prevent some people from getting the treatments they need.
The FDA has argued, though, that systematically gathering data in clinical trials is the way new drugs have been developed for decades and that this is an important part of the science of creating safe drugs.
You’re Not Alone
Through this brief summary, I’ve tried to outline the basics. But of course, you will want to explore in more detail at medicare.gov or by talking to a local Medicare representative.
When something like this happens in a family, it’s very personal, unique, and emotional. It can feel overwhelming, especially if you have not been through this before with any other family members. But it might help to know that Medicare currently covers over 5 million people with Alzheimer’s.
When you talk to representatives about it, you can have confidence knowing there are well-established procedures and you’re not bringing something new or difficult to figure out to them.
I do have an article on a related topic you might be interested in: Does Medicare Cover Home Health Care Services? Maybe your father is not at this point yet, but you and your family will want to start putting some thought into how to care for him when he is no longer able to live on his own.I hope this helps!
Yours,
Matt
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Author Bio Matt Feret is the author of the Prepare for Medicare book series and launched prepareformedicare.com to help people get objective answers to questions about Medicare. Matt is also the host of The Matt Feret Show. He has held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development, and strategy for over two decades.
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