Most medical costs to treat beneficiaries with Alzheimer's disease are covered by Medicare. Here is a breakdown of what Medicare (original) does and does not cover when it comes to Alzheimer's disease, along with tips that can help you plan ahead.
For the most part, ongoing medical care to diagnose and treat Alzheimer's disease is covered by Medicare Part B (visits to doctors, lab tests, speech and occupational therapy, home health care and outpatient counseling services).
Medicare pays 80% of these costs after your annual Part B deductible is met. You will be responsible for the remaining 20% of costs.
Inpatient hospital care is also covered under Medicare Part A after the annual deductible is met. And, as part of health care reform, Medicare is also covering 100 percent of annual wellness visits which includes testing for cognitive impairment.
Most Alzheimer's medications are covered under Medicare's Part D prescription drug plans but copayments vary from plan to plan. The Alzheimer's Association offers a chart on coverage for common Alzheimer's drugs. Visit www.alz.org and search for "drug chart."
If you don't have a Medigap (Medicare supplemental) insurance policy, you should consider getting one. A Medigap plan will help pay for things that aren't covered by Medicare like copayments, coinsurance and deductibles. For example, a Medigap plan F pays all deductible and all coinsurance plus any excess charges above what Medicare approves.
If you are enrolled in a Medicare Advantage plan (like an HMO or PPO), your plan must give you at least the same coverage as original Medicare, but make sure your doctors are in your insurer's network to avoid excess costs. Also ask if you need a referral or prior authorization before getting care.