Dementia is the progressive loss of mental abilities such as memory, reasoning and learning. It’s the leading cause of long-term care needs and often leads to severe disability later on in life. Here we explore whether Medicare covers home health care for dementia patients so families can better understand their coverage options.
Medicare, the federal health insurance program for people 65 and over, covers many services for dementia sufferers, such as in-home healthcare for early stages. Medicare may also pay for hospice care or short stays in nursing homes with dementia units; prescription drugs for Alzheimer’s or related forms may require a doctor’s order and come with a 20% copay fee.
Home health care for early stages of dementia typically entails skilled nursing and physical therapy services, in addition to skilled nursing. Along with managing pain, mobility issues and other medical needs, dementia-specific therapies may also assist in relieving behavioral and psychological symptoms. Therapists or nurses licensed as healthcare providers can address emotional, social or spiritual needs. Furthermore, care plans may be created and coordinated between various providers (social workers or psychologists).
As dementia worsens, its care needs increase to an insurmountable level and become unmanageable at home. At such point, a family may consider assisted living, which provides around-the-clock assistance with activities of daily living such as bathing and dressing/grooming, meal preparation/eating assistance as well as medication management – Medicare does not cover assisted living costs but there may be alternative means of coverage available to them.
People living with dementia in their middle or late stages may need 24-hour supervision and assistance with daily living activities in residential memory care facilities or nursing homes, which Medicare does not cover; however, Medigap policies may offer coverage for stays at these facilities.
People living with dementia frequently require ongoing treatments for multiple conditions, which can create costly out-of-pocket expenses. Luckily, caregivers can often reduce expenses with dual Medicare and Medicaid coverage; it reduces deductibles, copayments and coinsurance fees significantly.
Care costs associated with dementia care can be difficult for family caregivers at home to manage. Medicare offers some aspects of coverage for early and middle stage dementia patients as well as end-of-life hospice services, making the burden easier to bear.
Individuals can find out what types of dementia care are covered under Medicare by reaching out to their healthcare provider or reviewing current healthcare information. For additional coverage, Medicare Advantage plans often offer extra benefits that may help cover dementia-related expenses such as chronic care management service (CCMR) which provides development of treatment plan, coordination of services and medication management as well as 24/7 access to nurse or physician.