In this article, we will examine what benefits Medicare provides in the context of the needs experienced by Alzheimer’s patients in the early, mid and late stages of the disease. As the condition progresses, the care requirements for individuals stricken with the disease vary significantly. For each stage, we will examine what are the typical symptoms and behaviors, the associated care needs and which of those needs are covered by Medicare benefits.
For the purposes of this article, we define early-stage Alzheimer’s as the period of time during diagnosis and the first year following confirmation of the condition. At the early stage, the symptoms of the disease are not severe; they include difficulty finding the right words, performing basic math without paper, repeating questions and misplacing objects. Behaviorally, one may notice unusual mood swings especially when the stricken individual is presented with a socially or mentally challenging situation.
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None of these symptoms result in a need for care, but they are significant enough where one might become concerned and seek medical attention and that is where the expenses associated with Alzheimer’s care begin.
Diagnosing Alzheimer’s can be an expensive process because there is not a single definitive test. Instead the process consists of ruling out other conditions with similar symptoms which do have definitive tests and mental evaluations with a team of specialists including neurologists, psychiatrists and psychologists. Since this is a diagnostic process, Medicare Part B will cover 80% of the cost once an individual has paid their Part B deductible ($203 in 2021).
Following a diagnosis of Alzheimer’s, some individuals will require psychological counseling for the associated conditions like depression and aggression, or they might need physical and occupational therapies. Provided these services are considered medically necessary and prescribed by a doctor, Medicare Part B will pay 80% of these costs. In fact, recent changes to Medicare removed the caps on the amount of therapies individuals can receive.
It is worth noting that Medicare Supplemental Insurance can cover the 20% coinsurance that beneficiaries would otherwise have to pay themselves.There are also Medicare Special Needs Plans (SNP) designed specifically for individuals with Alzheimer’s.
A change to Medicare in 2017 was the addition of care planning as a service. Care planning helps patients to understand both what their medical options are, as well as alternative treatments, clinical trials, and even non-medical support. To be clear, Medicare won’t necessarily pay for all these services, but will pay to put together a plan to access them. For persons with Alzheimer’s and their families, care planning is a much needed as well as much overlooked benefit.
Most individuals will want to begin with Alzheimer’s medications soon after diagnosis; in some cases, certain medications have been shown to delay the progression of the disease. Medicare Part D helps pay for prescription drugs and most standard Alzheimer’s medications are on Medicare’s approved drugs list.
In 2021, the FDA approved Aduhelm, a new Alzheimer’s medication that costs $56,000 for a year of treatment (the drug does not cure Alzheimer’s, so patients will need to take it on an ongoing basis). It’s an infusion therapy, so it would be covered under Medicare Part B rather than Part D (Part D is for drugs that are obtained at a pharmacy, whereas Part B covers medications that are infused in a doctor’s office or hospital). Aduhelm’s FDA approval has been controversial, and CMS may impose coverage limits on how Medicare will pay for it. But even if it’s covered like any other infusion treatment under Part B, it would still leave beneficiaries with substantial out-of-pocket costs unless they have supplemental insurance, and is likely to result in premium increases for Medicare Part B.
As Alzheimer’s progresses into the middle stage, the associated symptoms become more severe. One can expect persistent memory loss and confusion associated with present and past events. There is a minor loss of motor skills and coordination, and slowness to movement. Mood changes also become more severe; often aggravated by the confusion the individuals are experiencing.
For the most part, the disease at this stage requires supervision and gentle reminders, but skilled care is not required. Some activities of daily living (ADLs) are compromised such as properly dressing oneself for the weather, taking medications, and eating. Therefore, personal care assistance may be required in addition to supervision.
Some families choose to provide personal care at home with the help of family members or home care aides, while other families prefer to receive personal care and supervision in an assisted living location or adult daycare. Assisted living specifically for persons with Alzheimer’s is referred to as “memory care.” Unfortunately, Medicare does not provide benefits for custodial care or supervision either at home or in memory care residences and the cost of memory care can be high.
Often, as Alzheimer’s progresses to the middle stage, families become interested in trying alternative therapies such as acupuncture or herbal medicine. As with personal/custodial care, alternative therapies are not a covered Medicare benefit.
In summary, while Medicare continues to pay for doctors’ visits and prescription drugs, there are few additional covered benefits by Medicare as one’s Alzheimer’s progresses from early to middle stage.
Late-stage Alzheimer’s is characterized by severe memory issues such as forgetting the names of spouses and caregivers, incontinence or great difficulty using a toilet, and even the loss of ability to respond to one’s environment. Behaviorally, individuals may become delusional or compulsive and experience hallucinations.
At this point, 24-hour care – either at home or in a skilled nursing residence – becomes necessary. Also, at this point, Medicare may begin to pay for additional services. However, qualification can be tricky and the coverage intermittent. Families may find themselves using a variety of Medicare services interspersed with their own caregiving.
While nursing home care may be required, Medicare will only pay for 100 days of skilled nursing care and it must be following a hospital stay. While persons with Alzheimer’s may require nursing home care, they don’t often have a precipitating event that necessitates a hospital stay. Medicare will pay for home health care for up to 35 hours a week, but the individual must be certified as “homebound.” While some late-stage Alzheimer’s patients may be physically able to leave their homes, they may still qualify as homebound because they are psychologically unable to function outside the home. Then again, they may not qualify because home health care is not supposed to be for a “continuous” need.
Finally, Medicare provides an all-inclusive hospice benefit for individuals determined to have less than six months to live. Very late-stage Alzheimer’s patients will qualify for this program which includes all palliative care that the patient needs, as well as counseling for the individual and their family.
Despite its shortcomings, Medicare, when used fully – and especially when augmented with Medicare Supplemental Insurance – can make a significant contribution towards the expense of caring for a loved one with Alzheimer’s.Readers may want to explore this article which discusses other Medicaid and Veterans’ benefits for Alzheimer’s.
But it’s important for families to be aware of the fact that Medicare will not cover extended stays in a nursing home or in-home long-term-care for seniors who need assistance with their activities of daily living due to Alzheimer’s (Medicaid does, if the patient has an asset level and income low enough to qualify for the program; you can click on a state on this map to see how Medicaid can supplement Medicare to provide comprehensive coverage for beneficiaries with limited financial resources). If a medical situation – a broken hip, for example – results in a hospital stay of at least three days, Medicare will cover up to 100 days for rehabilitation in a nursing home. But nursing home stays can extend far beyond that, and can cost thousands of dollars per month unless Medicaid or a long-term care insurance policy is available to pick up the tab.
In 2019, only about 7% of Americans age 50 or older had long-term care insurance, and many people find the premiums to be prohibitively expensive. But such coverage can complement Medicare, picking up the cost of custodial care while Medicare pays for “medically necessary” care.
Alex Guerrero is one the founders of PayingforSeniorCare.com, a sitecreated and maintained by the American Elder Care ResearchOrganization.
Tags: activities of daily living, Alzheimer’s disease, hospice care, in-home care, Medicare Part B, Medicare Part D, Medigap, Special Needs Plan
View all comments
2 years ago
My dad, a WWII veteran, has late-stage Alzheimer’s and is currently residing in a memory care facility in Bluffton, SC. The monthly costs are staggering. I wanted to know if there are any Medicare benefits to be had.
2 years ago
Reply toRandy Grundleger
If you have his DD 214 number you can call the veterans administration some of the facilities will help you get money but you must do the work yourself there is not a form they will tell you about but you must call in and ask for information for World War II vets that have Alzheimer’s I had my parents in a facility and I lost out on over $7000 because they help the World War II vet and they help the spouse but you have to ask them and you have to do the research to find the information they do not have it on the veterans website
2 years ago
How can I find out about the 35 hours Medicare will pay for home health care homebound know I need some assistance I’m caring for a friend and she’s getting worse and worse
2 years ago
More information about Medicare coverage for home care is here: https://www.medicareresources.org/faqs/how-much-in-home-care-will-medicare-cover/
10 months ago
Reply toJosh Schultz
The link above does not explain the 28 hours up to 35 hours of care. Can you elaborate what that includes and how to access?
Seasons Alzheimer’s Care and Assisted Living
2 years ago
Good analysis of benefits provided by medicare for Alzheimer’s patients in the early, mid and late stages of the disease. Keep up the excellent work!
2 years ago
Reply toSeasons Alzheimer’s Care and Assisted Living
My sister-in-law has late stage Alzheimer’s and my brother has late stage COPD and can’t take care of her. They live on Social Security with only a small savings. He is a Veteran they live in Iowa. What are their options?
2 years ago
Reply toSandra Siewert
I suggest researching whether they qualify for Medicaid. Here is an article about the home and community based services that Medicaid could cover for them: https://www.medicareresources.org/glossary/home-and-community-based-services-hcbs/.
This website has information about eligibility limits in Iowa: https://www.medicaidplanningassistance.org/medicaid-eligibility-iowa/
1 year ago
Reply toSandra Siewert
When we went to the VA to get my father assistance, the administrator told us he had to have been a veteran of a war and not a conflict in order to be eligible for benefits. Thankfully they recognized WWII as a war, but several others that are always referred to as wars were not considered that by the VA.
2 years ago
How can I fine a nursing home to my mother she had dementia she is 88 years old bad n my wife n I can’t take care of her we are also sick
N in our 70 , how can I fine a place right away
She has Medicare n Medicaid .
Can someone please tell me what I can do
2 years ago
Reply toLuz best
If she already had both Medicaid and Medicare there is not much else but to start researching/ contacting individual nursing homes to see if they suit her needs. If they do not accept Medicaid likely they can inform you of some that do. Or your state Medicaid website should have the info somewhere. Once you choose one most will guide you if not handle most of the insurance transition , depending your state Medicaid may need to be changed from one status to another.. and they will do and income asset check looking back at 5 yrs. Because the homes cost more state verifies there’s no hidden monies to pay for it. Hope this helps, try not to jump through unnecessary hoops. Seem like you got it under control.
Karla V. Busch-McEwen
2 years ago
I am POA for a very close friend with stage 6 Alzheimers, no children or husband, after trying to care for her in her home for 1.5 years, she began to need 24 hour care, which I could not provide and she could not afford. Now she is in a very good memory care facility but costs are so high. Where do I go to find out if she can get help with her memory care expenses?
2 years ago
Reply toKarla V. Busch-McEwen
I am sorry to hear about your close friend. Depending on her income and assets, she might be eligible for Medicaid, which could help with some of those costs: https://www.medicareresources.org/medicare-benefits/how-medicaid-supports-1-in-5-medicare-enrollees/
1 year ago
How do I access the Care Planning Services that Medicare added in 2017?
Mom is 88 diagnosed with Dementia Early Alzheimer’s we think she’s in the middle stage memory is shot, she’s not eating much and we would like to tap into this Planning Service for guidance and moving forward so we know where we are going with her care. I called Medicare today and was told that I have to have her Doctor order this service. What does the doctor do call Medicare and set up a Social Worker to evaluate her and set up the plan?? The Medicare representative really didn’t know anything about this Service. I need guidance could someone tell me how this works.
Thank you so much!
If you are living with dementia, or caring for someone with the condition, you may be eligible for some benefits if dementia affects your ability to work, or if you have extra costs because of it.What resources are available to assist the family of a patient with Alzheimer's disease? ›
- NIA Alzheimer's and Related Dementias Education and Referral (ADEAR) Center. ...
- Alzheimers.gov. ...
- Alzheimer's Association. ...
- Alzheimer's Foundation of America. ...
- Eldercare Locator. ...
- National Institute on Aging Information Center.
Other benefits you may be eligible for include Income Support, Housing Benefit, Council Tax Reduction and Pension Credit.What support is there for people with Alzheimer's? ›
Charities for people with dementia
It also has information and advice about living with dementia and finding help and support near you. Alzheimer's Society runs the Dementia Connect support line on 0333 150 3456, which provides information and advice about dementia.
In most cases, the person with dementia will be expected to pay towards the cost. Social services can also provide a list of care homes that should meet the needs identified during the assessment.Is Alzheimer's considered a disability for Medicare? ›
If you or someone you care for has been diagnosed with early-onset Alzheimer's, they will qualify for Medicare after receiving disability benefits for 24 months.Does Medicare cover caregivers for dementia patients? ›
Many people with dementia will need some kind of long-term care that includes custodial care. Custodial care involves help with daily activities such as eating, dressing, and using the bathroom. Medicare doesn't typically cover long-term care. It also doesn't cover custodial care.What happens to Alzheimer patients with no family? ›
You may be at increased risk for harm, falls, wandering and/or malnutrition. You also may have difficulty managing personal hygiene or household tasks, which can lead to unsafe living conditions. Plan ahead for how you will address your basic needs, including housing, meals and physical care.What resources are available for people with dementia? ›
National nonprofit organizations, such as the Alzheimer's Association, Alzheimer's Foundation of America, Lewy Body Dementia Association, Lewy Body Dementia Resource Center, Association for Frontotemporal Degeneration, and National Task Group on Intellectual Disabilities and Dementia Practices.Can you get money for having dementia? ›
If your symptoms of dementia will prevent you from working for 12 months or more, you may qualify for Social Security Disability (SSD/SSDI) or Supplemental Security Income (SSI) benefits. You can apply for SSDI benefits if you are not currently receiving retirement benefits.
Carer's Benefit is €220 a week per single care recipient. Someone caring for two or more people may receive a higher rate of €330 a week. If you have children you may be able to apply for an Increase for a Qualified Child.Is dementia considered a Social Security disability? ›
If your symptoms of dementia have prevented you from working for 12 months or more, you may be eligible for Social Security Disability benefits. You can apply for SSDI if you are not currently receiving retirement benefits; once you reach full retirement age, SSDI benefits automatically change to retirement benefits.How long can Alzheimer's patients live at home? ›
On average, a person with Alzheimer's lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors. Changes in the brain related to Alzheimer's begin years before any signs of the disease.What smart device can help Alzheimer's? ›
GPS location and tracking devices.
Location tracking devices are a great option for those who have dementia and may wander. Tracking devices can be worn and many have alert systems that let a caregiver know if their loved one has left a certain area.
On average, people with Alzheimer's disease live between three and 11 years after diagnosis, but some survive 20 years or more. The degree of impairment at diagnosis can affect life expectancy. Untreated vascular risk factors such as hypertension are associated with a faster rate of progression of Alzheimer's disease.Do I have to sell my mom's house to pay for her care? ›
The simple answer to this is no – you cannot be forced to sell your home to pay for care. But many people will have to contribute to the cost of their care in later life or even meet the full cost.Do dementia patients need a care home or a nursing home? ›
A person with dementia will need more care and support as their condition progresses, and there may come a time when they will need to move into full-time or residential care. This could be because a care home may be able to meet the needs of the person better.Do I have to pay for my mother nursing home? ›
You're not obligated under any law to pay for any family member's fee. This applies to your parents, wife, husband, or relatives by law. Unless you append your signature with the care provider promising to pay the fees, you're not legally obliged to pay.Can you get SSI for Alzheimer's? ›
Administered by the SSA, SSDI makes monthly payments to eligible disabled individuals and is a significant benefit for individuals with early-onset (younger-onset) Alzheimer's disease.What is a compassionate allowance for Social Security? ›
Compassionate Allowances are a way to quickly identify diseases and other medical conditions that, by definition, meet Social Security's standards for disability benefits. These conditions primarily include certain cancers, adult brain disorders, and a number of rare disorders that affect children.
Conditions classified as terminal illness
Dementia (including Alzheimer's) Advanced heart disease. Motor neurone disease.
The leading cause of death in Alzheimer's patients is a secondary infection, commonly pneumonia. Bacterial infections could be easily remedied with a course of antibiotics in healthy individuals.Should someone with Alzheimers be left alone? ›
People with dementia should not be living alone without care if they are suffering any cognitive impairment that could lead to them coming to any harm at home. Some common signs that a person with dementia can no longer live independently include: They are struggling with personal hygiene.What stage of Alzheimers Do they not recognize family? ›
Moderately severe stage
In this stage of Alzheimer's disease, the person: Has significant confusion. May not consistently recognize his or her children or spouse, or may confuse them with other family members.
There are a range of memory aids to help people remember important things. Whiteboards are useful for writing lists and reminders. Clocks with large faces are easier to read, and can display the date, and even the time of day. Diaries and calendars are useful for keeping track of appointments and routines.What's the difference between Alzheimer's and dementia? ›
While dementia is a general term, Alzheimer's disease is a specific brain disease. It is marked by symptoms of dementia that gradually get worse over time. Alzheimer's disease first affects the part of the brain associated with learning, so early symptoms often include changes in memory, thinking and reasoning skills.Who is responsible for a person with Alzheimer's? ›
Conservator: A person appointed by the court to make decisions on behalf of the person living with dementia; referred to as the guardian in some states.Can you get power of attorney if someone has dementia? ›
In general, a person with dementia can sign a power of attorney designation if they have the capacity to understand what the document is, what it does, and what they are approving. Most seniors living with early stage dementia are able to make this designation.Can someone with dementia be cared for at home? ›
In-home care includes a wide range of services provided in the home, rather than in a hospital or care community. It can allow a person with Alzheimer's or other dementia to stay in his or her own home.How much is carer's Allowance every week? ›
If eligible, Carer's Allowance is £69.70 a week (£3,624.40 a year). It can also be backdated for up to three months. This is paid directly into your bank account, building society or credit union account. You can also choose for Carer's Allowance to be paid every week or once a month.
Carer's Allowance is the main benefit for carers. If you are looking after someone for 35 hours a week or more, you may be eligible. This information applies to people living in England, Wales, Scotland and Northern Ireland. Carer's Allowance is currently paid at £69.70 a week (2022-23).How much is the Carers Grant 2022? ›
It was announced that carers who qualify for the Carer's Support Grant will get a once-off payment of €500 the week starting 21 November 2022. You will get one payment of €500 only, even if you are caring for more than one person.How long can you collect Social Security Disability? ›
To put it in the simplest terms, Social Security Disability benefits can remain in effect for as long as you are disabled or until you reach the age of 65. Once you reach the age of 65, Social Security Disability benefits stop and retirement benefits kick in.What types of income do you have to report to Social Security Disability? ›
WHAT THINGS MUST YOU REPORT TO SOCIAL SECURITY? Change of address. Change in living arrangements. Change in earned and unearned income, including a change in wages or net earnings from self-employment, including your spouse's income if you are married and living together, and parents' income if applying for a child.What can cause you to lose your Social Security Disability benefits? ›
- Court-Order Continuing Disability Reviews. ...
- Making Too Much Income. ...
- Retirement or Turning 18. ...
- Arrest and Imprisonment. ...
- Protect Your Disability Benefits by Working With a California Disability Lawyer.
A person with late-stage Alzheimer's usually: Has difficulty eating and swallowing. Needs assistance walking and eventually is unable to walk. Needs full-time help with personal care.How does Alzheimer's end in death? ›
The vast majority of those with Alzheimer's die from aspiration pneumonia – when food or liquid go down the windpipe instead of the esophagus, causing damage or infection in the lungs that develops into pneumonia.What is death from Alzheimer's like? ›
The way people with Alzheimer's disease die is different from person to person, but there's a basic pattern to the process. They slowly lose the ability to control basic body functions, such as eating, drinking, and toileting. After a while, their body shuts down. They can't move much on their own.What helps calm Alzheimer's patients? ›
- Music. Music therapy helps seniors calm down and reflect on happier times. ...
- Aromatherapy. ...
- Touch. ...
- Pet Therapy. ...
- A Calm Approach. ...
- Move to a Secure Memory Care Community. ...
- Maintain Routines. ...
- Provide Reassurances.
For men and women with Alzheimer's disease or other forms of dementia, it can be especially beneficial. Watching movies and TV shows can help keep their brain active, which can stimulate positive memories, improve mood, and even increase socialization.
Keep well-loved objects and photographs around the house to help the person feel more secure. Try gentle touching, soothing music, reading, or walks. Reduce noise, clutter, or the number of people in the room. Try to distract the person with a favorite snack, object, or activity.What stage of Alzheimer's is shuffling? ›
Shuffling of the feet in a person with Alzheimer's or dementia typically occurs in the moderate to severe to later stages of the disease. Shuffling is a common cause of falls in affected people because sliding feet can more easily trip on rugs, door thresholds or even slightly uneven surfaces.At what stage do Alzheimer's patients sleep a lot? ›
Sleeping more and more is a common feature of later-stage dementia. As the disease progresses, the damage to a person's brain becomes more extensive and they gradually become weaker and frailer over time.What stage of Alzheimer's is anger? ›
Is there an anger stage of dementia? Not really. A person with dementia will progress through the stages of dementia but the changes have to do with level of functioning, not with anger. That being said, we can cause a person with dementia to be angry without realizing it.How does Alzheimer's affect you financially? ›
Early on, a person with Alzheimer's may be able to perform basic tasks, such as paying bills, but he or she is likely to have problems with more complicated tasks, such as balancing a checkbook. As the disease gets worse, the person may try to hide financial problems to protect his or her independence.What is the average lifespan for a person with Alzheimer's? ›
The rate of progression for Alzheimer's disease varies widely. On average, people with Alzheimer's disease live between three and 11 years after diagnosis, but some survive 20 years or more. The degree of impairment at diagnosis can affect life expectancy.Does Alzheimer's qualify for PIP? ›
The decision over whether you can get PIP will be based on the impact that dementia has on your daily life and ability to live independently. The assessment looks at 12 day-to-day activities, such as preparing a meal, dressing and mobility (for example, planning and following journeys).What happens to dementia patients with no money? ›
If an elderly person has no money and no family to assist them, and they encounter a health emergency that prevents them from living alone, they may become a ward of the state. A guardian will be assigned to help make decisions about their living situation.What usually causes death in Alzheimer's patients? ›
The leading cause of death in Alzheimer's patients is a secondary infection, commonly pneumonia. Bacterial infections could be easily remedied with a course of antibiotics in healthy individuals.What is the most common cause of death in dementia patients? ›
One of the most common causes of death for people with dementia is pneumonia caused by an infection. A person in the later stages of dementia may have symptoms that suggest that they are close to death, but can sometimes live with these symptoms for many months.
National nonprofit organizations, such as the Alzheimer's Association, Alzheimer's Foundation of America, Lewy Body Dementia Association, Lewy Body Dementia Resource Center, Association for Frontotemporal Degeneration, and National Task Group on Intellectual Disabilities and Dementia Practices.What stage of Alzheimer's requires assistance? ›
As memory and cognitive skills further decline, personality changes may take place and individuals need extensive care. At this stage, individuals may: • Require around-the-clock assistance with daily personal care.
You could get between £23.70 and £152.15 a week, depending on how your condition affects you. How do I claim? Call the Department of Work and Pensions PIP claims on 0800 917 2222 between 8am and 5pm, Monday to Friday.