Does Medicaid Cover Dementia Care


Medicare Annual Wellness Memory Test

Does Insurance Pay for Dementia Care?

In January, 2011, the Affordable Care Act health law created the Medicare Annual Wellness Visit, which should be completed during an older adults annual checkup after joining Medicare.

This Annual Wellness visit provides preventative health services and also focuses on detecting any form of cognitive impairment in the patient. The test should only take about five minutes to complete.

A cognitive impairment test is searching for any sign of short term memory impairment, which is a common trait of those who are in the early stages of dementia most notably Alzheimers disease.

The test can also include evaluation of planning and reasoning skills .

During the Medicare Annual Wellness Visit, the seniors primary care doctor will perform either a paper or online test, or may use a combination of both. Doctors tend to prefer to use online diagnostic tests as they are typically more accurate.

Here are a few reasons someone should be tested, according to the Alzheimers Association:

  • Individuals with memory concerns or other cognitive complaints. Non-memory triggers include personality change, depression, deterioration of chronic disease without explanation, and falls or balance issues
  • Informant reports of cognitive decline or impairment, with or without patient concurrence
  • Medicare beneficiaries, as part of the Annual Wellness Visit

The Alzheimers Association also notes that additional benefits of testing include:

Why Early Diagnosis Is So Important

When a patient comes in with cognitive complaints, doctors consider their medical history, the severity of the symptoms and the speed of their onset. Some forms of dementia are reversible with treatment, says John Moore, DO, an Aetna medical director and senior health specialist. Its very important to see your primary doctor if you suspect that you are or someone you care for is displaying signs of dementia.

There is no definitive test for Alzheimers. Doctors generally make an Alzheimers diagnosis only after eliminating other possibilities they can test for. Those tests may include:

  • Physical and neurological exam. To evaluate reflexes, eye movements, walking and balance.
  • Lab work. Blood tests can reveal cardiovascular disease and other underlying conditions.
  • Brain imaging. As a last resort, an MRI or CT can reveal a tumor, stroke or blot clot.

Potentially curable causes of dementia include vitamin deficiency, thyroid problems, stress and depression . Reactions to prescription drugs are another common factor. As we get older, our liver and kidneys slow down, making medications linger in our system longer. Adjusting your dosage and timing can eliminate chemical buildups that have a toxic effect on brain cells.

Can I Give Money Away For Medicaid Qualification

No! I had a call recently where Mom/Dad were both coming off of the wait list and were finally going to be able to qualify for Medicaid. The problem was that Mom/Dad had over $70,000 in the bank – which is some $67,000 over the asset limit for a married couple. The representative from the Aging Resource Center told the family that Mom and Dad could give this money away and apply for Medicaid – but that was just plain wrong. You cannot give money away within 5 years of a Medicaid application! Here, an elder law attorney can help legally protect assets and apply for Medicaid – hiring the attorney will more than pay for itself.

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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.

Understanding Different Medicaid Programs

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

Critical to understanding Medicaid, is understanding the difference between institutional Medicaid and Home and Community Based Services . Institutional Medicaid is provided in nursing homes. Home and Community Based Services, as implied by the name, are Medicaid services provided to individuals living at home or in the community. The phrase in the community includes adult foster care homes / adult family homes, adult day care, and assisted living residences, including assisted living specifically designed for persons with dementia called Memory Care or Alzheimers Care. HCBS are meant to prevent people living with dementia from premature nursing home admission due to the progression of the disease. As a side note, many states have their own names for their Medicaid program. For example, in California it is called Medi-Cal, in Massachusetts, MassHealth, and in Washington State, Apple Health.

Institutional Medicaid Institutional Medicaid, also called nursing home Medicaid, is an entitlement in all 50 U.S. states and the District of Columbia. This means, should the individual be eligible for Medicaid, the state must pay for their nursing home care.

Did You Know?

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Medicare Coverage: What Is A Medicare Special Needs Plan

A Special Needs Plan is Medicare coverage available through a type of Medicare Advantage plan.

A Chronic Condition SNP covers people who qualify by having a certain health condition. Your mom must have that condition to be able to enroll in one of these plans. There are SNPs for people with dementia. You can search Medicare Advantage plans in your moms area by entering his zip code in the box on this page.

Private insurance companies approved by Medicare can offer these plans. SNPs can charge a monthly premium. Your parent will also continue paying a Part B monthly premium. Some SNPs might pay a part of the Part B premium, if your parent qualifies.

Quality Dementia Care In Texas

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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Personal Savings & Assets

Personal savings and assets often fund the help needed after a dementia diagnosis.

These funds typically come from:

  • The sale of a home and/or estate
  • An existing savings account
  • Help from friends or family members

However, personal savings can also come from investments or personal property such as fine art or valuable jewelry.

Does Medicaid Cover Dementia Care

Difference between Skilled Nursing and Assisted Living? Does Medicaid pay for Assisted Living?

Yes, Medicaid covers a wide range of dementia care costs, including Alzheimers care and memory care costs.

However, Medicaid may not cover all dementia care costs or the costs of certain services or support communities. Before moving forward with a dementia treatment plan, it is essential to understand the limitations and requirements involved in using Medicaid funds.

Recommended Reading: What Are The Qualifications For Medicaid In Colorado

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.

Who May Receive Nursing Facility Services

NF services for are required to be provided by state Medicaid programs for individuals age 21 or older who need them. States may not limit access to the service, or make it subject to waiting lists, as they may for home and community based services. Therefore, in some cases NF services may be more immediately available than other long-term care options. NF residents and their families should investigate other long-term care options in order to transition back to the community as quickly as possible.

Need for nursing facility services is defined by states, all of whom have established NF level of care criteria. State level of care requirements must provide access to individuals who meet the coverage criteria defined in federal law and regulation. Individuals with serious mental illness or intellectual disability must also be evaluated by the state’s Preadmission Screening and Resident Review program to determine if NF admission is needed and appropriate.

Nursing facility services for individuals under age 21 is a separate Medicaid service, optional for states to provide. However, all states provide the service, and in practice there is no distinction between the services.

In some states individuals applying for NF residence may be eligible for Medicaid under higher eligibility limits used for residents of an institution. See your state Medicaid agency for more information.

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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.

Ways To Pay For Memory Care

Does Medicaid Cover In

Additional Lifestyle Articles

For families with a loved one diagnosed with Alzheimer’s related dementia’s Certified Assisted Living and Memory Care Facilities provides a safe and comfortable home-like environment. These specialized memory care communities are designed exclusively for individuals diagnosed with Alzheimer’s disease and other types of memory impairments.

People with Alzheimer’s disease require regular medical care as well as some special care that might include medications or other interventions. Medical services are often covered under medical insurance . It may be important to examine the health coverage to determine the extent of coverage limitations or co-pays and deductibles.

Memory care is more expensive compared to traditional senior living options, but the care provided is more comprehensive.

It costs, on average, about $3,300 per month for a one bedroom apartment. The average cost of memory careis about $5,000 for a single resident, but such facilities go quite a bit further to effectively provide care for those with Alzheimers or other dementias, with 24-hour supervised care for patients at all stages of the disease.

There are four primary payment options for covering the cost of residential memory care. Private pay , Long-term care insurance, Medicare & Medicaid.

Programs for Veterans

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Example Of Accessing Hcbs For Assisted Living

Mom, age 91, was living at home with advancing dementia. Mom falls and breaks a hip, going to the hospital and then to the skilled nursing facility to receive rehabilitation. While in the nursing home, the family decides that the elder is not able to go home due to safety reasons. The family hires an elder law attorney to assist with a Medicaid application. After 30 days of receiving rehabilitation, the elder’s Medicare benefits stop paying for rehabilitation. With the attorney’s Medicaid application in the works, the elder will stay in the nursing home until the Medicaid application is approved. After 60 days and Medicaid approval, the elder will be able to leave the nursing home and go to an assisted living facility with assistance from Medicaid.

This scenario is in contrast to moving Mom directly into the assisted living facility from her home. Even if Mom is financially eligible for Medicaid and she is in the ALF, she would only join the Medicaid wait list – so there is no assurance that Medicaid will help with her assisted living costs, even if she is out of money.

Common Questions About Medicaid Benefits For Assisted Living

Paying for assisted living doesnt all have to be from your own pocket. One preferred way to pay is through Medicaid.

Medicaid is a state-administered public health insurance program that gives health care coverage to families or individuals with low incomes. It is the leading government-assistance program for long-term care and assisted living.

Here are 5 common questions people ask about Medicaid and helping to pay for assisted living.

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Assistance For Veterans With Alzheimers

While the VA does not have programs specifically for individuals with dementia or Alzheimers, there are benefits available through other VA programs that are available and relevant to veterans with these conditions. A pension benefit known as Aid and Attendance can provide the greatest amount of financial assistance. Up to approximately 2,230 / month in some cases. There is also VA Respite Care and other assistance available through Veterans Directed Home and Community Based Services.

Medicare Cognitive Test Questions

What To Do After Dementia Diagnosis | Long Term Care Education

The Medicare Cognitive Test is an examination to test ones memory function, particularly their short term memory.

It is a 30 question test that asks relatively simple questions such as: What is the month? or What year is it? This exam is the one that is generally used to help screen for dementia.

The test can also be used to get an estimate of the severity and progression of an individuals cognitive impairment and to track the changes in someones cognitive performance during subsequent years. Additionally, it is an effective way of tracking an individuals response to treatment.

The test questions are not designed to trick the person in any way. They are only being used to determine whether or not someone potentially has dementia, and if they do, to help decide the best course of action to take in their treatment.

If you have concerns about yourself or a loved one, talk to your primary care doctor.

While the Medicare Annual Wellness Test should be done as part of your annual checkup, if you are worried about memory problems, rest assured that you do not need to wait a year to ask for a cognitive examination.

Recommended Reading: Can You Receive Both Medicare And Medicaid

Does Medicare Cover Dementia Care At Home

The primary treatment for Alzheimers and other types of dementia is caregiver care. Having an in-home caregiver to care for a loved one with dementia can be life-changing. Both for you and your loved one. However, caregiver care can be quite expensive.

So a common question many people have is, does Medicare cover dementia care at home? In this article, we answer that question in clear, plain English. You will also find the average costs of home dementia care and other helpful info.

How Can Medigap Help With Dementia

Medigap plans will cover the coinsurance payments youd otherwise be responsible for paying. Our agents can help you find a policy that makes sense for your situation. Give us a call at the number above to learn about your rates today! Or, fill out an online rate form to see your rates now!

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When It Comes To Dementia What Does Medicare Cover

Medicare does pay a portion of medical expenses for dementia patients, but there are limitations.

Prescription Drug Coverage

The drugs prescribed to treat the symptoms of dementia can be costly, according to the National Institute on Aging. While Medicare Part D will typically cover the cost of some medicines commonly prescribed for dementia, the Alzheimerâs Association notes that each Medicare Part D plan will offer specific types of coverage. In order to get the most out of Medicare Part D, the Association recommends that you:

  • Determine which plans will pay for all or most of the drugs you currently take
  • Make sure that the medications you currently take are on your chosen planâs formulary
  • Ensure that the specific doses of your medications are covered by your chosen plan
  • Review plan details for any limitations on medications for Alzheimerâs disease or âprior approvalâ requirements
  • Determine which plans require you to try a cheaper, similar drug before paying for your preferred medications
  • Make sure that you understand any limits on the number of pills that a prescription may cover over a specific period of time, also known as a âquantity limitâ
  • Compare final costs of each potential planâincluding not only the monthly premium, but also the deductible, copays, and coinsurance costs
  • Ensure that your local pharmacy or mail-order prescription service is included in your chosen planâs pharmacy network

Coverage During All Stages of Dementia


Does Medicare Cover Dementia Care

How Do I Find Quality Medicaid Memory Care Near Me ...

Medicare covers some, but not all, of the costs associated with dementia care. This includes:

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.

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