What Is Medicaid And How Is Medicaid Different From Medicare
Medicaid is government-provided health insurance for low-income Americans regardless of age.
While the two names are similar, Medicaid is not the same program as Medicare, which is government-provided health insurance for Americans over the age of 65 regardless of income level. Medicaid benefits include coverage for long-term non-medical services that people with Alzheimers disease and other types of dementia often need. Medicare does not cover these services except through some optional, supplemental Medicare Advantage plans.
Another critical distinction between Medicaid and Medicare is that Medicare benefits often require some out-of-pocket payments, whereas Medicaid does not. Many people over the age of 65 carry both Medicaid and Medicare insurance.
Does Medicare Cover Alzheimers Testing
Whether you have dementia or Alzheimers you can expect coverage to be available. Medicare does cover Alzheimers testing. A doctor will run various tests before an Alzheimers diagnosis. Often, these tests require visits to the neurologist, neuropsychologist, and geriatricians. Testing can include physical examination as well as laboratory tests.
Finding The Best Alzheimers Care Available
If youve looked into the question what is Medicare Supplement insurance and researched D, F, and C, you still might find that it doesnt cover all your needs. In that case, its best to also look into long-term care insurance outside of Medicare/Medigap. Unfortunately, Medicare and Medigap simply dont offer the comprehensive coverage that Alzheimers patients typically need, so it can be tough for patients, families, and caregivers to afford care even with government help.
With that said, its important to look into your choices, learn more about your Medicare Supplement options and determine if youre going to enroll in Original Medicare, a Medicare Supplement plan, long-term care insurance, or maybe even all three.
Whats important is that Alzheimers patients and their families and caregivers are protected and not worried about the finances. They need to simply focus on the care and ensure that patients are receiving the best coverage possible for the rest of their lives.
If youre ready to look further into the question, What is Medicare Supplement insurance? and research Medicare Supplement plans for Alzheimers, use Ensurems Medicare Supplement Quote tool.
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Where Can I Find Medicaid And Medicare Memory Care Services Near Me
- Medicaid recipients: Contact your State Medicaid Agency.
- Medicare recipients: Call 1-800-MEDICARE . TTY users call 877-486-2048.
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What Other Options Exist To Pay For Senior Care
Most long-term senior care is not medical in nature, falling into the personal care category. Personal care is not covered by Medicare or Medicaid unless its provided in a skilled care setting under a skilled care plan in a skilled care facility. Even then, there are limits. This means that many times, the costs of senior care will need to be paid for using alternative means which may include:
- Personal savings and retirement accounts
- Long-term care insurance policies purchased prior to the need for them
- Reverse mortgages allow homeowners to draw on the equity of their home
- Some life insurance policies allow a certain percentage of the policys face value to be used to pay for costs such as these under certain conditions
- Accelerated death benefits may be allowed under certain conditions by life insurance policies
- Long-term care annuity contracts
- A life settlement
Some of these options have conditions and restrictions that must be met, while others require prior planning and purchase prior to needing them.
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What Are The Common Care Costs For Alzheimers Disease
According to the Alzheimers Association, these are some of the most common types of costs you can anticipate when creating your loved ones Alzheimers care plan:
- Ongoing medical treatment, including diagnosis and follow-up visits
- Safety-related expenses, such as home safety modifications or safety services for a person who wanders
- Prescription drugs
Then, there are the different types of daily and long-term caretaker services, such as:
- Adult day care services
- In-home care
- Full-time residential care
The type of care thats right for you will vary depending on your loved ones situation, but at-home care services tend to be the preferred option for many Alzheimers patients. In their Cost of Care Survey, Genworth Life Insurance Company calculated the median costs for these long-term care services for seniors in 2020. These were their findings:
- In-home care with a non-medical health aide: $23 per hour and $1,012 per week.
- Adult day services: $75 per day.
- Assisted living facilities: $4,051 per month or $48,612 per year.
- Private room in a nursing home: $280 per day or $102,200 per year.
- Semi-private room in a nursing home: $247 per day or $90,155 per year.
Keep in mind that these figures are medians, so the actual numbers will vary depending on your geographic location and the level of care that is needed for your loved one. Clearly, the costs of long-term care services can add up quickly, so finding the right insurance to help pay for the costs is important.
Payment Options / Financial Assistance For Alzheimers Care
For most families, the expenses of caring for a loved one with Alzheimers or dementia are covered not by a single source, but instead by contributions from a variety of sources. Some of these resources are specifically designed for Alzheimers patients and others are of a more general nature.
Dementia Care Central is a free website that offers tips, suggestions, and videos on how to provide hands on care and gain the cooperation of persons with Alzheimers. Visit their site.
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Alzheimers Home Care Pros And Cons
Pros of home care for dementia:
- Home is familiar and comfortable
- Your loved one can develop a more personal one-on-one relationship with their caregiver
- Typically less expensive than a nursing home
- Seniors can remain as independent as possible
Cons of dementia home care:
- Home may be less secure for seniors prone to wandering
- Your loved one may also need skilled medical home health care
Does Medicaid Pay For Assisted Living Communities
Your parent would qualify for Medicaid if they have a low income and few assets besides their home. Medicaid is funded partly by the government and partly by the states. Thats why qualifications for an individual to receive this type of coverage varies.
Many people wonder about Medicaid assisted living coverage. Almost all state Medicaid programs will cover some assisted living costs for eligible residents. However, similar to Medicare, Medicaid does not pay for the cost of living in an assisted living community.
For qualified seniors, Medicaid does pay for these assisted living services:
- Nursing care
- Medical exams
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Does Medicare Cover Dementia Care
Medicare covers some, but not all, of the costs associated with dementia care. This includes:
- inpatient stays at facilities like hospitals and skilled nursing facilities
- home health care
- prescription drugs
What isnt covered and how to help pay
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 doesnt typically cover long-term care. It also doesnt cover custodial care.
However, there are other resources that may help you to pay for long-term and custodial care. These include things like Medicaid, the Programs of All-inclusive Care for the Elderly , and long-term care insurance policies.
Medicare Part A covers inpatient stays at places like hospitals and skilled nursing facilities. Lets look at this a little more closely.
What Is Not Covered Under Medicare For Alzheimers Care
Original Medicare does not cover some of the most expensive services for Alzheimers patients. Patients, or their families, could be 100% financially responsible for some of the following healthcare costs.
- Long-Term or Custodial Care.Long-term care is a big expense and is not covered by Original Medicare or Medicare Advantage plans. Medicare will pay for medical care provided in a facility or adult day care but does not pay for personal care services or assistance with activities of daily living .9 These are the average 2020 monthly costs for nursing homes and other outsourced care:11
- Home-based care: $4,481-$4,576
- Nursing home : $7,756
- Nursing home : $8,821
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How To Plan For Future Care Costs
The disconnect between care needed and care covered can cause financial trouble and stress for families coping with an Alzheimers diagnosis. Adler suggests considering options and making plans before long-term care becomes a necessity.
People need to understand long-term care insurance and Medicare, as well as the different types of coverage available and the different housing options within their communities.
Other options for families include Medicaid for low-income patients or private health insurance. Whatever option families choose should be planned for before the needs arise, giving families time to find the best and most affordable option for a parent or senior loved one.
Are you a caregiver to a senior loved one? How do you cover long-term care costs associated with Alzheimers? Wed like to hear your stories in the comments below.
Does Medicare Cover Assisted Living For Alzheimers
Although Medicare does not cover assisted living for Alzheimers or dementia, Medicare benefits do apply to some treatment programs.
For example, Medicare covers hospice care for dementia patients. Most Medicare plans will provide hospice care at home, at a nursing home or assisted living facility, or at the hospital based on the doctors recommendation.
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Kaiser Permanente Insurance To Pay For Nursing Homes & Skilled Nursing
Many seniors who have a Kaiser Permanente policy will have coverage for nursing homes and skilled nursing care. These locations provide medical care alongside the supportive care individuals need for day to day living. The company has a network of skilled nursing facilities that it uses to help cover its policyholders needs. Those who have the Kaiser Permanente Medicare Advantage Plan or another commercial plan from the company that includes senior care in a nursing home or skilled facility will gain this type of coverage.
In order to access this coverage, the individuals doctor must admit the patient to the location. That is, a doctor must agree that this type of care is necessary. Then, he or she must use a facility that is provided within the coverage plan. Also, not all plans offer this type of coverage.
Kaiser Permanente Insurance To Pay For Hospice Care
Hospice care provides support for individuals who are facing the end of their life and need health coverage throughout that time. There are some Kaiser Permanente coverage options available here. There are some policies that cover both palliative care and hospice care. Most of the time, an individual who needs hospice care will have high medical bills as well as significant medication needs. This type of coverage is generally a part of the Kaiser Permanente insurance coverage.
In addition, those who have Medicare or Medicaid, with or without Kaiser Permanente coverage, generally have access to hospice cover. This type of coverage often includes senior centers offering hospice care, 24-hour locations, specialized hospice centers, as well as in-hospital care for hospice needs. In order to access this type of care, a medical doctor overseeing the care of the patient must make the decision that hospice is necessary. This will be necessary to obtain before entering any location for this type of care.
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Obamacare And Alzheimer’s Coverage
The Affordable Care Act, also known as the ACA or Obamacare, includes several provisions aimed at people of all ages who have dementia.
Most have to do with Medicare or Medicaid, however, rather than coverage average Americans can buy through the insurance marketplaces set up in the wake of the ACA’s passage.
What Does Medicare Cover For Dementia
Medicare will cover up to 100 days in a skilled nursing facility for Alzheimers patients who were transferred from the hospital for physical or speech therapy, but long-term memory care for dementia patients is not covered.
Depending on your Medicare plan, medically necessary costs such as treatment for injuries from falls and minor accidents, doctors fees, and other in-patient hospital care may be covered. And in certain circumstances, if a patient qualifies, Medicare will cover up to 35 hours per week of in-home care.
Medicare will also cover a portion of your Alzheimers prescriptions, and you can choose to purchase Medicare Supplemental Insurance to cover any remaining prescription costs.
Medicare benefits are limited, and you may have to speak with a Medicare insurance agent about how and if you qualify. Enter your ZIP code below to get multiple quotes.
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Alzheimers Nursing Home Pros And Cons
Pros of a nursing home for Alzheimers:
- May be more secure for people prone to wandering
- Staffed with a variety of medical professionals
Cons of nursing homes for Alzheimers:
- Very expensive, especially for high-quality places
- Remove an individuals independence
- Can be a difficult transition for anybody, especially those with memory issues
-According to one study, residents with dementia or Alzheimers disease are at greater risk of abuse.
Humana Insurance To Pay For Assisted Living
Assisted living is a long-term care option in an apartment-like accommodation where basic assistance with activities of daily living is provided. Since the care provided is non-medical in nature, costs are not covered by Medicare or Medicaid. The only type of insurance that can be used to pay for assisted living costs is a long-term care insurance policy. Neither Humanas healthcare insurance nor their Medicare supplemental insurance policies cover the costs of an assisted living facility. Check the coverage of individual long-term care insurance policies to verify their coverage for assisted living.
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What Other Financial Help Is Available For Individuals With Dementia
Individuals living with Alzheimers may be eligible for financial support through several government programs:
- Social Security Disability Insurance: Individuals under the age of 65 whove been diagnosed with early onset Alzheimers may be eligible for SSDI benefits if they meet other program criteria. The disability decision may be fast-tracked through the Social Security Administrations Compassionate Allowances program.
- Supplemental Security Income: Disabled seniors age 65 and over who have a limited income and assets may qualify for SSI, which provides monthly benefits to cover basic needs such as food, shelter and clothing.
- Medicaid: Low-income seniors or individuals whove used up their savings on long-term care may be eligible to enroll in Medicaid. Because this program combines state and federal funds, eligibility rules and program specifications vary by states. In some areas, individuals under 65 may qualify for Medicaid. Medicaid typically covers long-term care.
Medicare Special Needs Plans For Alzheimers Patients
Medicare Advantage offers Special Needs Plans created specifically for seniors with Alzheimers disease and other dementia disorders. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. You need a reference from a specialist to participate in an SNP.2
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Covering The Gaps With Medicare And Dementia
Medicare Part A and B both have deductibles for which you are responsible. Part B also only covers 80% of your outpatient costs. You are responsible for the rest.
If you are enrolled in a Medigap plan, it will help to cover some or all of these costs. Its important to enroll in supplemental coverage before you develop dementia or any other serious or chronic condition. All Medicare beneficiaries have a 6-month Medigap open enrollment window when they first enroll in Part B. During this window, you can enroll in any Medigap plan without health questions or underwriting.
Medicare beneficiaries also have the option to consider enrollment into a private Medicare Part C plan instead of Original Medicare. Your cost-sharing for Medicare Part A, B and D services will vary by the plan you choose.
Need help with covering the gaps in Medicare? Call us today at 1-855-732-9055.
Who Is The Population With Dementia That Is Covered By Medicaid
Medicaid beneficiaries with dementia differ from those who are not covered by Medicaid by gender, race, and income . Medicaid beneficiaries with dementia are more likely to be female and are more racially diverse than the non-Medicaid population with dementia. Unsurprisingly, given Medicaidâs financial eligibility criteria, Medicaid beneficiaries with dementia are more likely to have low incomes than those who are not covered by Medicaid. Consequently, Medicaid beneficiaries with dementia have few financial resources available to pay for care out-of-pocket. In addition, because nearly half of Medicaid beneficiaries with dementia live alone, they may not have regular access to unpaid caregiving from a family member.
Medicaid beneficiaries with dementia are more likely to report being in fair or poor health compared to those without Medicaid. Given their reported poorer health status, Medicaid beneficiaries may need more intensive care and/or a broader scope of services to manage their greater health needs. Nearly all Medicaid beneficiaries with dementia have multiple chronic health conditions, indicating that they may benefit from care coordination services and/or efforts to better integrate medical, behavioral health, and long-term services and supports.
Figure 1: Socio-Demographic Characteristics of Adults with Dementia in the Community, by Medicaid Coverage Status
Figure 2: Health Characteristics of Adults with Dementia in the Community, by Medicaid Coverage Status
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