Alzheimer’s Care and Medicare: What You Need to Know

Medicare covers “medically necessary” costs, but that term can be confusing when it comes to long-term care for people with Alzheimer’s disease. Does custodial care fall under a “medically necessary” expense? Learn more about Medicare and Alzheimer’s care.

Alzheimer's Care and Medicare: What You Need to Know

The Most Expensive Disease

Alzheimer’s caregivers are no strangers to the cost of Alzheimer’s. While the disease has a devastating physical and emotional cost, the financial cost is putting many families into medical debt. Care costs range from $21 per hour for in-home care to $239 per day for an assisted living community, and the Alzheimer’s Association estimates that Alzheimer’s care costs are expected to reach $214 billion in 2014. This makes the disease the most expensive condition in the U.S.

There are currently 5 million Americans on Medicare who have Alzheimer’s. Despite the growing costs of Alzheimer’s disease, long-term care for people with Alzheimer’s is usually considered an issue of custodial care, and thus, not covered under Medicare.

This issue is part of a larger issue facing the country. With the elderly population expected to double to 88 million people by 2050 and an estimated 70% of those people needing long-term care, families are looking for a financial solution.

Custodial Care vs. “Medically Necessary” Care

Medicare coverage can be confusing for many people. According to Linda Adler, founder and CEO of Pathfinders Medical, a patient advocacy group, if the care is not considered “medically necessary” it will not be covered by Medicare.

Most people with Alzheimer’s need what Medicare calls “custodial care.” This kind of care is non-medical and aids the patient with dressing, eating, cleaning and other activities of daily living. Adler of Pathfinders Medicals said:

“There was a time when the family could come together and care for elders at home. But families now are different in many ways, and often when patients are in need of basic care, they are unable to get it from traditionally available sources.”

Planning for the Future

The disconnect between care needed and care covered can cause financial trouble and stress for families coping with an Alzheimer’s diagnosis. Adler suggests considering options and making plans before long-term care becomes a necessity. She said:

“People need to understand Medicare, long-term care insurance, 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 and anticipated before needs arise, giving families time to find the best and most affordable option for a loved one. 

Should Medicaid cover long-term care costs associated with Alzheimer’s disease? Share your thoughts with us in the comments below.

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Please leave your thoughts and comments

  • Sloan

    If we’d stop giving all the freebe,s to all the illegal aliens and con artists and Obama stop giving our money by the billions to his Islamist cult pals and start taking care of the Amereican people who pay taxes to be cared for.Get rid of this corrupt Government and Obama death care and the big health company,s stop ripping the people off we’d be in great shape in a few years ,i think so anyway.

  • Matt

    Yes it should. Familes save their whole lives just to have it whiped out because of the term “Medically Necessary”. To ALZ and Demitia patients and their families. It is medicaly needed.

  • CasyK

    What a horrible country we live in. It doesn’t make sense to work hard all your life and pay taxes and in the end if you get dementia or Alzheimer’s you are literally screwed. If you have too much money you end up going broke, if you have no money you get care but what is the quality of the care? I am very disappointed in this country and how the elderly are treated. My Mom was on hospice and after 6 months they bailed on her.. my Dad refuses to go into assisted living he has to pay care takers to come in but she is not getting proper care.. he is 97 she is 95 the family helps but everyone has their own lives and it isn’t fair that elderly have to struggle to survive after a long hard life. My dad served in WWII and VA is only worried about him paying for healthcare and anything he needs.. This country is screwed up big time. The politicians priorities are self motivated. SO sad!

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