Will Medicare Cover Dementia for My Elderly Parent?

Does Medicare pay for home health care for dementia patients?

Diagnosis and Testing

When diagnosing dementia, doctors may use physical and neurological exams, medical history, physical exams, diagnostic testing and brain imaging. Primary care physicians often, with the help of neurologists and geriatric physicians, use a variety of tools to determine if a person has dementia. It may be difficult to determine the exact cause of the diagnosis.

Diagnostic testing can be an expensive process as there is no single diagnostic test that determines if a person has dementia, the most common form of Alzheimer’s disease. Since this is a diagnostic process Medicare Part B (medical insurance) may cover 80% of the cost once the deductible is reached.

Medicare part B (up to 80%) may also cover annual cognitive assessments or testing related to dementia care as part of the Medicare Annual Wellness visit as well as any additional diagnostic testing that is ordered by your doctor.

Supplemental Insurance or Medicare Advantage Plans may provide additional coverage for home modifications, such as grab bars.

Psychological Counseling

After a diagnosis of Alzheimer’s dementia some may require psychological counseling for related issues such as depression and aggression. If the services related to treating these behaviors are considered medically necessary and prescribed by a doctor, Medicare Part B will pay 80% of these costs. Medicare Supplemental Insurance can cover the remaining 20% and can increase the range of medications needed.

Physical Therapy

Medicare Part B helps pay for medically necessary physical therapy. Physical therapy ordered by your doctor to help improve cognitive function is considered medically necessary. Out of pocket pay for the remaining 20% would be required or you can explore Medicare supplemental insurances (HMO of PPO).

Medication

In most cases it is best to begin taking dementia medications immediately as this may delay the progression of the disease. Medicare Part D helps pay for prescription drugs and most commonly used medications that are on the Medicare’s approved drug’s list. During the Medicare Annual Enrollment Period, Medicare Beneficiaries can enroll in a drug plan.

The below medications do not cure dementia but may help with dementia symptoms:

Antidepressants:

  • Prozac
  • Zoloft
  • Celexa

Anxiety:

  • Ativan
  • Serax

Antipsychotic:

  • Abilify
  • Seroquel
  • Haldol
  • Clozaril

Skilled Nurse

Some families choose to have nursing care at home. Medicare will cover home services by a skilled nursing professional if the person is not able to leave his or her home, requires speech, occupational and or physical therapy, requires temporary, part time nursing care and a doctor deems the services necessary.

Some of the services a Skilled Nurse will provide include in your home are:

  • Critical care
  • Catheter or colostomy maintenance
  • Wound care and dressing changes
  • Injections and IV therapy
  • Implementation of physician-ordered medical care
  • Phlebotomy (blood draws)
  • Prevention of pressure ulcers
  • Hip replacement/joint replacement post-surgical care
  • Pain management and palliative care

Please visit https://www.seniornannies.com/skilled-nursing/ or give us call so we can discuss your families care needs.

Custodial Care

Personal or custodial caregivers provide non-medical assistance or services, these services are not covered by Medicare. Below is a list of custodial care services:

  • Assistance with daily activities including bathing, toileting, medication reminders, walking
  • Companionship and encouragement to help in dealing with loneliness, depression, aggression and frustration.
  • Household chores such as light housekeeping, cooking, and laundry
  • Driving/transportation and shopping

Please refer to https://www.seniornannies.com/home-care-services/ for a complete list of custodial care services.

Activities of Daily Living (ADL)

As dementia progresses the ability to perform activities of daily living are affected. Activities of daily living include bathing, dressing, reminders needed to take medications and eating.  Therefore, personal care assistance may be needed. Assistance with Activities of daily living are not covered by Medicare. These services are typically paid out of pocket. A home health aide can provide assistance with activities of daily living.

Nursing Home Care

In the later stages of dementia, living at home may not be feasible as 24/7 care may be needed. Families may turn to nursing home care. Nursing home care is covered by Medicare part A, but it will only cover 80% of the cost of nursing home care for a maximum of 100 days if nursing care is required after a hospital stay.

If you have a Medicare advantage plan (HMO or PPO) or other Medicare health plan, you should check with the plan to see if the nursing home care stay is covered. It usually is not covered by a Medicare advantage plan unless the nursing home has a contract with the plan.

Hospice

Medicare covers hospice when a doctor determines that the patient has 6 months or less to live. The coverage includes doctor, nursing, personal care along with grief counseling and prescription drugs. Coverage also includes durable medical equipment such as, hospital beds, infusion pumps and supplies and oxygen equipment as well as any other equipment order by the doctor. The coverage is provided if the patient is at home or receiving care at a hospice facility or nursing home.

You’re Not Alone

Although this condition can be daunting for you and your loved one, you are not alone. More than 16 million Americans provide care for people with dementia and Alzheimer’s. It is important to remember that taking care of a loved one battling this condition can be tiresome and you should take care of yourself physically and mentally. Providing care for a person with dementia involves a team of people, therefore it is recommended that you ask for help.  Whether you provide daily care giving or are involved only in the decision making, or simply care about the person with dementia, we offer resources to help. Connect with a professional today and we can provide expert guidance on a care plan for your loved one.