Gaps in Medicare Coverage for Alzheimer’s Disease Care

Gaps in Medicare Coverage for Alzheimer’s Disease Care In 2022, an estimated 6.5 million Americans ages 65 and older were living with Alzheimer’s dementia, according to the Alzheimer’s Association.

Alzheimer’s disease is a progressive brain disease that affects memory and cognitive function. There is no cure.

Most people with Alzheimer’s disease have Medicare, but the program lacks coverage for several services patients often need as the disease progresses.

Alzheimer’s Disease Services That Are Not Covered Under Original Medicare

• * Extended nursing home stays


• * Assisted living facilities


• * Adult day care


• * Custodial care (assistance with activities of daily living, such as bathing, eating and dressing)


• * Many patients use Medicaid to fill coverage gaps, including nursing home care.

According to a 2015 Kaiser Family Foundation analysis, about a quarter of adults with dementia are covered by Medicaid over the course of a year.

Patients must have low incomes and limited assets to qualify for Medicaid.

Some people may qualify for both Medicare and Medicaid. This is known as dual eligibility.

A Dual Eligible Special Needs Plan, or D-SNP, is a specific type of Medicare Advantage plan that includes at least the same coverage as Original Medicare (Part A and Part B) as well as Part D prescription drug coverage. But D-SNPs usually offer additional benefits, such as dental, vision, nursing home care, personal care, and home- and community-based services.

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