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

Last Updated: January 28, 2019

Medicare is a federal health insurance program that covers “medically-necessary” costs, but the term can be confusing when it comes to eligibility for long-term care for people with Alzheimer’s disease in the United States.Alzheimer's Care and Medicare: What You Need to Know

Does custodial care fall under a “medically necessary” expense? Learn more about Alzheimer’s care costs and Medicare.

Alzheimer’s Costs and Medicare

Alzheimer’s caregivers are no strangers to the costs of the disease. Alzheimer’s has devastating emotional and physical costs, but its financial costs are putting many families into medical debt. According to the 2018 Costs, Accountabilities, Realities and Expectations (C.A.R.E.) Study, the average Alzheimer’s care cost in 2018 was $273 per month, with 67% of caregivers polled reporting reducing their own living expenses to pay for costs associated with the disease.

The Alzheimer’s Association also estimates that the disease will cost the nation $277 billion this year, with costs growing to $1.1 trillion by 2050.

Unfortunately, regardless of the rising costs of Alzheimer’s, long-term care for people with the disease is usually considered an issue of custodial care, and thus, not covered under Medicare.

Custodial Care vs. “Medically Necessary” Care

According to Linda Adler, CEO and Founder 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 cleaning, dressing, eating and other activities of daily living (ADLs). Adler says:

“There was a time when the family could come together and care for seniors 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.”

How to Plan for Future Care Costs

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.

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

Are you a caregiver to a senior loved one? How do you cover long-term care costs associated with Alzheimer’s? We’d like to hear your stories in the comments below.

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