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.
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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