Alzheimer’s and Medicare Coverage

According to the Alzheimer’s Association, it is estimated that over six million Americans are living with Alzheimer’s disease.

  • Approximately 1 in 9 people age 65 and older have Alzheimer’s.
  • Women make up close to two-thirds of Americans with Alzheimer’s.
  • Older Black Americans are almost twice as likely to have Alzheimer’s or other dementias as older Whites.
  • Older Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older Whites.

If you or someone you know has recently been diagnosed with Alzheimer’s or other cognitive impairment, Medicare will cover care planning services. The ability to plan gives individuals and their families opportunities to learn about medical and non-medical care, and services available in their communities. Planning care will also identify clinical trials and support that can contribute to a higher quality of life.

What Does Medicare Cover for Alzheimer’s Disease?

Medicare will help pay for care with medical and mental health conditions.  Examples include:

Original Medicare (Part A and Part B) covers the diagnosis, evaluation, treatment, and care planning for Alzheimer’s disease.

Medicare Part A covers:

  • Inpatient hospital stays, psychiatric care, and skilled nursing facility care
  • Home health care
  • Hospice care

Medicare Part B will cover:

  • Outpatient services such as doctor’s visits
  • Therapy – Physical, Occupational and Speech
  • Diagnostic testing such as CT scans and MRIs.
  • Some Medications that are needed and given at the doctor’s office.

Original Medicare (Part A and Part B) may cover mental health services such as inpatient psychiatric care and outpatient counseling and behavioral health care. A social worker can even visit a patient at home to counsel and assist with the social and emotional side of Alzheimer’s disease. A doctor must order these services.

Prescription Medications – Medicare drug plans (Medicare Part D) must include certain types of prescription drugs used to treat Alzheimer’s disease. Each plan must cover prescriptions that raise the levels of chemicals in the brain to assist with memory and judgment.  Each prescription plan must cover a minimum of two different prescriptions in two different medical categories. Medicare Coverage for New Alzheimer’s Drug –  For more information click the following – NEW DRUG COVERAGE


Care Planning and Medicare

Care planning is a covered service with original Medicare for Alzheimer’s patients. Benefits of care planning in the ability to learn about medical and non-medical treatments available. Patients and caregivers can also learn about clinical trials and community services and resources to help improve the quality of life.

According to the Alzheimer’s Association the following services covered by Medicare:

  • Evaluating cognition and function
  • Measuring neuropsychiatric symptoms
  • Medication reconciliation
  • Evaluating safety (this includes the ability to drive)
  • Identifying caregivers and the needs of caregivers’
  • The identification and assessment of care directives
  • Palliative care needs and planning
  • Referrals to community services for the Alzheimer’s patient and caregiver

Non covered services with Original Medicare

It’s important to note that Medicare Part A and Part B may not cover everything you need for Alzheimer’s care. Individuals with middle-stage Alzheimer’s and late-stage Alzheimer’s often need more and/or additional care including things like long-term care or an assisted living facility.

The following will not be covered by Original Medicare:

  • Over-the-counter vitamins and supplements
  • Incontinence supplies
  • Adult day care
  • Custodial care in a nursing home
  • Respite care (except as under the Part A hospice benefit)
  • Personal aide assistance (except as provided under the Part A home health care benefit)

If you or a family member are seeking assistance or a support group, click the following hyper link to find a chapter near you.


References and Sources (pdf)