Will Health Insurance Cover Dementia Care?

When Alzheimer’s disease or other forms of dementia make themselves known in your family, whether in yourself or a loved one, there’s a lot of information to get up to speed on. What are the symptoms? How quickly does it progress? What does dementia care look like? These questions center around dementia itself, learning all you can about it in the hopes of coming to terms with it and understanding what the future may hold. Along with these questions, families find themselves trying to get a grasp on the practical aspects of dementia and dementia care. Who provides care? Where does that care take place? How much does memory care cost? And how are we going to pay for it?

The answers to these questions differ for every dementia patient and every family, especially when it comes to the question of how dementia care will be paid for. To get a clear picture of your financial options, it’s necessary to talk to a financial professional who can take a close look at your particular situation. Hopefully, the information below will help to give you an idea of the questions to ask.

Medication and Short-Term Care

For most families, Medicare and Medicaid play an integral role in paying for memory care. While they each come into play at different times and provide different options, a helpful mental shorthand is to link Medicare in your mind with medication and short-term care, and to associate Medicaid with long-term care.

Assessment and Planning

In January of 2017, Medicare began providing coverage for cognitive assessment and person-centered care planning services. Alzheimer’s and dementia patients and their caregivers can avail themselves of this coverage. This is great news, as these services can help provide clarity as your family begins their journey with dementia. Through these services, dementia patients can visit a trained medical professional who will assess cognition, evaluate symptoms, and identify caregiver needs, as well as assess the safety of performing everyday tasks like cooking and driving, and review medications.

Medication and Medicare Part D

Medicare partners with medical insurers to offer a variety of prescription drug plans. These plans are covered in Medicare Part D, with annual open enrollment periods during which Medicare beneficiaries can choose the plan that’s best for them. While the specifics of each plan differ, most standard dementia medications are covered.

Short-Term Care and Skilled Nursing

Medicare will typically cover up to 100 days of skilled nursing care. This generally involves a short-term stay in a skilled nursing facility, where dementia patients can receive physical therapy, speech therapy, and occupational therapy.

Supplemental Insurance

Medicare coverage involves copays and deductibles that need to be paid out-of-pocket by patients. Private insurance policies known as Medigap plans can help cover these out-of-pocket costs. Medicare Special Needs Plans (SNPs), which specialize in providing coverage for dementia patients, are also available.

Long-Term Care and Memory Care Communities

Eventually, Alzheimer’s and dementia progress to the point where dedicated, ongoing care is needed. This often involves a permanent move into a memory care community, or full-time at-home care provided by a trained professional. As these services extend indefinitely, they go beyond the 100-day limit set by Medicare. For long-term care such as this, patients and their families can look into Medicaid to provide coverage.

If you’ve got more questions about paying for dementia care in general, or specifically about dementia care in the Chicago area, please feel free and encouraged to give us a call here at Lexington Square. You can reach us by phone at 630-812-7241, or by email.

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