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Does Medicare Pay For Home Health Care For Dementia Patients

What Can Adult Day Care Provide To Adults With Dementia

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According to the Alzheimers Association, more than 15 million Americans provide unpaid care for people with Alzheimers and other dementias. While friends and family may be able to provide some care for adults suffering from dementia, at times these unpaid caregivers may need a break so they can attend school, go to work, or carry out other life duties.

According to eldercare.gov, adult day care centers can provide care and companionship for older adults who need help and supervision during the day. Eldercare.gov lists two types of adult day care.

  • Adult social day care provides recreation, meals, social activities and some health services, although the focus is on the activities.
  • Adult day health care offers intensive health, therapeutic, and social services to those with more serious medical conditions. Other services that adult day care centers could provide include: counseling, evening care, physical therapy, transportation, and medication management.

Medicare Supplement Plans Or Medigap

If you have original Medicare , you may be able to purchase a Medicare supplement plan, also called Medigap.

Some Medigap plans pay for the coinsurance costs for Part B, which may help you pay for home health services. However, these plans dont offer expanded home health service coverage.

Some people choose to purchase separate long-term care insurance, which isnt a part of Medicare. These policies may help to cover more home health care services and for longer time periods than Medicare. However, the policies vary and do represent an extra cost to seniors.

Medicare Doesnt Cover: Custodial Or Memory Care

As symptoms advance, most Alzheimers and dementia patients need help with activities of daily living like personal hygiene, eating, dressing, and bathing.

Medicare refers to these services as custodial care and generally will not cover them.

But Investopedia notes two exceptions: the care is considered medically necessary and prescribed by a licensed physician or authorized medical personnel, and the care is conducted by a healthcare provider who participates in Medicare.

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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 Advantage For Alzheimers And Dementia Patients

Medicare and dementia: Coverage, eligibility, and costs

The official U.S. government website for Medicare reports that Medicare Advantage plans offer the same benefits as Medicare Part A and Part B, including:

  • Up to 100 days in a nursing home
  • Up to 35 hours a week of home health care for homebound people
  • Most medical care, including regular visits with a doctor and hospital care for infections and other issues

Additionally, the Centers for Medicare & Medicaid Services notes that, once Medicare Advantage beneficiaries begin receiving hospice care from a Medicare-approved provider, Original Medicare will cover all needs related to their terminal illness. These patients can retain their Medicare Advantage coverage as long as they continue to pay its premiums, and use either Original Medicare or their Advantage coverage for health issues unrelated to their terminal illness.

Every Medicare Advantage plan is different, so itâs important to read the plan documents and compare the plans available in your state. Some additional benefits various plans offer include:

  • Prescription drug coverage, including for dementia drugs
  • Additional in-home care beyond the 35 hours per week original Medicare authorizes
  • Meal deliveries

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Medicare Does Cover: Some Rehabilitative Care

If home health services like physical or occupational therapy are needed after a hospitalization, Medicare will cover these treatments to an extent.

As long as its considered rehab and not long-term care, Medicare will pay for up to 100 days of care in a skilled nursing facility each benefit period, according to U.S. News & World Report.

In cases where temporary home health care is needed, Medicare will also cover 35 hours a week for 60 days at a time.

Does Medicare Cover Memory Care Facilities

Many assisted living facilities also have memory care wings. There are also standalone memory care facilities.

Memory care units are designed to meet the needs of people with Alzheimers and other dementias.

They are usually more expensive than standard assisted living. Medicare treats memory care the same as assisted living. It only covers medical expenses, not rent, meals, or assistance.

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Will Medicaid Pay For Long

Many Medicare enrollees are qualify for Medicaid due to their limited incomes and assets. Unlike Medicare, Medicaid covers both nursing home care and Home and Community Based Services .

Due to the high cost of long-term care, many states have higher Medicaid income limits for long-term care benefits than for other Medicaid coverage. However, Medicaids asset limits usually require you to spend-down resources before becoming eligible.

Late Stage Alzheimers Disease And Medicare Coverage

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In late stages of Alzheimers disease, individuals require extensive care twenty-four hours a day, including personal care assistance. An individual who has Alzheimers disease at this stage commonly has profound memory loss, may no longer be able to communicate verbally, and either will need help walking or cant walk at all. He or she may have incontinence, as well as angry or aggressive outbursts. At this point, family caregivers often can no longer provide the care that is needed.

People with late stage Alzheimers often require full-time nursing home care. Unfortunately, Medicare generally does not cover long-term care. Most nursing home care is personal care, or custodial care, which involves help with daily living tasks like eating or bathing. Medicare only covers skilled nursing care in certain situations, like during a short-term stay at a skilled nursing facility after a qualifying hospital stay. However, if you are a Medicare beneficiary with limited income, many state Medicaid programs cover long-term services, including nursing home care. This may be an option you can look into, and you can find out more by contacting your states Medicaid program.

In the final stages of Alzheimers disease, hospice care may be needed. Hospice care is covered by Part A, and it includes coverage for a variety of services ordered by the hospice physician, including:

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Find A Medicare Advantage Plan Today

Medicare Advantage plans are privately sold alternatives to Original Medicare. By law, they must cover the same benefits as Original Medicare.

If you receive hospice care, you will still receive it from Medicare Part A.

Some Medicare Advantage plans offer benefits that Original Medicare doesn’t offer, such as prescription drug coverage and caregiver support services.

Learn more about the other additional benefits that may be covered by Medicare Advantage plans where you live.

Find Medicare Advantage plans that cover palliative care

Or call to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports:

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.

Medicare Advantage Plans May Offer More Benefits For Dementia Care

As part of the Chronic Care Act of 2018, Medicare Advantage plan providers are able to provide expanded benefits to their beneficiaries, called supplemental benefits, starting in 2019 and 2020.

Some of these additional benefits may include:

  • Home modifications, such as bathroom grab bars
  • Non-medical home care, such as custodial care
  • Adult day care

Because Medicare Advantage plans are sold by private insurance companies, plan availability and the benefits they offer may vary from one location to another.

To learn more about Medicare Advantage plans in your area, your eligibility to enroll, and the benefits that they offer, call to speak with a licensed insurance agent today.

Compare Medicare Advantage plans in your area

Or call 1-800-557-6059TTY Users: 711 24/7 to speak with a licensed insurance agent.

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State Or Local Assistance Programs

Some states offer financial support for people with dementia through a general fund not managed by Medicaid. Many of these programs operate within strict guidelines, such as only providing in-home dementia care or only paying for regular visits to an adult recreation center. In Texas, memory care support falls under the Community Care for Aged/Disabled program. People interested in this option should contact Texas Health and Human Services.

Local governments or municipalities and nonprofit organizations may also offer financial support. To learn more about these options, contact the closest chapter of the Alzheimers Association or the closest Area Agency on Aging in Texas.

When Should You Call Your Doctor

Does Medicare pay for nursing home?

911 or other emergency services immediately if signs of a or develop suddenly. These may include:

  • Numbness, weakness, or inability to move the face, arm, or leg, especially on one side of the body.
  • Vision problems in one or both eyes, such as dimness, blurring, double vision, loss of vision, or feeling like a shade is being pulled down over your eyes.
  • Confusion, or trouble speaking or understanding.
  • Trouble walking, dizziness, or loss of balance or coordination.
  • Severe headache with no known cause.

if a person suddenly becomes confused or emotionally upset or doesn’t seem to know who or where they are. These are signs of , which can be caused by a reaction to medicines or a new or worsening medical condition.

Call a doctor if you or a person you are close to has new and troubling memory loss that is more than an occasional bout of forgetfulness. This may be an early sign of .

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Veterans Affairs Benefits For Memory

The U.S. Department of Veterans Affairs covers some memory care costs for qualifying military veterans. The VA programs that are most likely to provide aide for memory care services include:

  • Home-based Primary Care offers home health care to veterans with complex medical needs that cant be handled in the clinic setting.
  • Homemaker or Home Health Aide offers assistance at home to veterans who need help with activities of daily living, like bathing, toileting, and dressing.
  • Respite Care provides relief for family members who are providing in-home care by sending temporary help when they need time away.
  • Adult Day Health Care offers a place for you or your friend or relative to go during the day for life enrichment and social engagement.

Spouses of military veterans with dementia may also receive support through the VA.

Through its extensive healthcare system, the VA can also help cover doctors appointments, dental care, and vision care. Most people who served in active naval, military, or air service and did not receive a dishonorable discharge will qualify for VA benefits and should check with the department as soon as possible.

Can Medicare Supplement Insurance Help With Expenses Associated With Alzheimers Disease

Medicare supplement insurance, or Medigap, is private insurance thats designed to cover out-of-pocket expenses remaining after Medicare reimbursement. Although these plans dont provide additional health insurance coverage for seniors, they can defray costs associated with Alzheimers care, including:

  • Deductibles

Medigap policies vary by plan type and may offer different benefits, coverage amounts and deductibles.

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Do Medigap Plans Cover Dementia

Medigap plans cover the same healthcare services like Medicare. That means a Medigap plan wont pay for assisted living or in-home help.

But, a Medigap plan can pick up where Medicare leaves off when it comes to paying for doctors and Medicare-covered home health. Also, the Medigap plan can pay the daily copay for a stay in a skilled nursing facility and extend the number of covered days of care.

Quality Dementia Care In Texas

Care Options for People With Alzheimers

Paying for dementia care can be stressful, but ultimately, finding the right dementia or memory care community can greatly alleviate the burden on you and your family. Memory care can provide a more supportive, positive lifestyle for your relative or friend with dementia, giving them the care and attention they need to enjoy every day.

If youre looking for memory care in Texas, consider Villages of Windcrest. We provide a comfortable home for residents with dementia in Fredericksburg, Texas, along with an expert staff that can provide the personalized support every individual needs. For more information on our services, contact us online or download our free Memory Care Guide.

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Medicare Advantage Special Needs Plans For Alzheimers Disease

Special Needs Plans are a type of Medicare Advantage plan that can offer specialized care and coverage specifically limited to patients with a certain condition or situation, such as dementia or Alzheimers disease.

Medicare SNPs are not available in all locations. If an SNP is available near you, you may be able to enroll and enjoy benefits such as:

  • Providers who specialize in treating dementia
  • A care coordinator who helps manage all of your health care services, medications, diet and more
  • Additional prescription drug coverage for specific drugs that help treat your dementia

Learn more about the Medicare SNPs that may be available in your area and if you meet the eligibility criteria. If none are available, you may be able to find another type of Medicare Advantage plan that fits your coverage needs.

How Much Will I Have To Pay If I Qualify

With Original Medicare coverage , eligible seniors will pay nothing for home health care services that are ordered by a doctor and provided by a certified home health agency. Any additional services provided outside of the approved care plan will not be covered and must be paid for out of pocket.

Be aware that before services begin, the home health agency should provide an itemized receipt or plan of care that identifies what is eligible for Medicare coverage and what is not. A written notice called the Advance Beneficiary Notice of Noncoverage will detail any services and durable medical equipment that Medicare will not pay for as well as the costs the patient will be responsible for.

Use the guide below to determine the combination of payment options that will help your family cover home care costs.

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Background: Factors Driving Change

Demographic impetus and cost

The graying of the U.S. population is a major impetus for change in health care. According to the Medicare Payment Advisory Commission , Medicare enrollment is projected to increase by more than 50% over the next 15 years from 54 million beneficiaries today to more than 80 million in 2030. This reflects an overall aging of the United States population: the Census projects that by 2030, the proportion of U.S. residents older than 65 will have nearly doubled from 2010 . Among the oldest Americans, the Census predicts that the population age 85 and above will double by 2036 and triple by 2049.

Although by some accounts the upcoming Medicare population is healthier than previous generationsâlife expectancies are longer and smoking rates have declinedâbaby boomers have higher rates of obesity and diabetes compared with previous generations. According to a 2002 study, 88% of people 65 years or older have at least one chronic condition, with a quarter of these having four or more conditions. The effect of these chronic conditions on spending is massive: Estimates suggest that chronic illness accounts for three quarters of total national health care expenditures. As the number of older beneficiaries with multiple chronic conditions continues to rise, providing care in the most effective and efficient setting will become even more critical.

Health care delivery system reform: The Triple Aim and HHS goals

  • Improving the patient experience of care

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    Does Medicare Pay For Nursing Home Care For Dementia ...

    Medicare covers seniors over 65 years old.

    Medicare is available for certain people with disabilities who are under the age of 65. That includes people who have received Social Security Disability Insurance for a total of at least 24 months, have end-stage renal disease or permanent kidney failure, or have Lou Gehrigs disease .

    If you qualify for Medicare, its still not certain that your long-term care will be covered. Medicare concentrates on short-term care for conditions which will eventually improve.

    This means Medicare will not pay for most long-term home care services or personal services such as help bathing, dressing, or help going to the bathroom.

    To help you understand you or your loved ones ability to finance respite care or home care services, Visiting Angels offers free consultations over the phone and at your home.

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