Medicare Doesnt Cover: Custodial Or Memory Care
As symptoms advance, most Alzheimers and dementia patients need help with activities of daily living like personal hygiene, eating, dressing, and bathing.
Medicare refers to these services as custodial care and generally will not cover them.
But Investopedia notes two exceptions: the care is considered medically necessary and prescribed by a licensed physician or authorized medical personnel, and the care is conducted by a healthcare provider who participates in Medicare.
Does Medicaid Pay For Home Health Care
If your Medicaid health plan covers Personal Care Services you may be required to use Medicaid State Plans to cover home healthcare for you. Home care is not covered by the insurance company. The Medicaid Waiver system enables Medicaid recipients to have access to home care rather than nursing homes.
Does Medicare Advantage Cover Dementia
Advantage plans must offer the same benefits as Medicare. That means you can expect your Medicare Advantage plan to cover an annual dementia screening as well as medical costs.
Medicare Advantage plans come with deductibles, copays, and doctor networks, so your costs may be different than if you had Medicare.
Advantage plans could benefit dementia patients:
- A Medicare Special Needs Plan for dementia is tailored to the needs of dementia patients.
- Some Medicare Advantage plans may offer in-home long-term care benefits beyond whats available under traditional Medicare. These benefits might include adult daycare, nutrition services, or in-home caregiving.
Advantage plans vary by location. Plans geared toward dementia and long-term care may or may not be available in your area.
You May Like: Is Medicare Advantage Plan Worth It
The Cost Of Memory Care
Memory care typically costs 20% to 30% more than assisted living, depending on where the memory care facility is located, the number of amenities and the type of programming the facility offers. According to the 2019 Genworth Cost of Care Survey, the average cost of assisted living across the United States is $4,051 per month. To find out the average cost of memory care nationally, we added 25% to the cost of assisted living Memory care in the U.S. costs about $5,064 per month.
Even though memory care is most often provided in an assisted living facility and includes the same personal care services and amenities, memory care costs are higher than assisted living because it requires specialized staff training, therapy and programming as well as specific facility design and security.
How To Pay For Memory Care: 7 Surprising Ways
Although memory care is commonly financed through savings, there are several additional funding sources that many people dont know about. There are also many professionals who can provide clarity on this complex and naturally emotional topic.
When parents need long-term care, especially if its sudden, it can be very overwhelming, says Michelle Ash, a certified financial planner in Jacksonville, Florida, and Chartered Advisor for Senior Living. Try to stop, take a breath, and make a list of financial sources that can help you access some short-term immediate funds while you get your head around the bigger financial picture.
From veterans benefits to home equity to life insurance policies and more, learn how to pay for memory care and how to find financial guidance or resources to reduce stress along the way.
Don’t Miss: Does Medicare Pay For Freestyle Libre
Alzheimers Resource Locator Tool
Our websites database contains information on over 300 programs that provide financial assistance or reduce the cost of caring for the elderly. Many of these programs are specifically applicable to those suffering from Alzheimers, dementia or other related memory disorders. One can search specifically for programs relevant to them by entering their demographic information into our Resource Locator Tool.
Eldercare Financial Assistance Locator
What Is Not Covered Under Medicare For Alzheimers Care
Original Medicare does not cover some of the most expensive services for Alzheimers patients. Patients, or their families, could be 100% financially responsible for some of the following healthcare costs.
- Long-Term or Custodial Care.Long-term care is a big expense and is not covered by Original Medicare or Medicare Advantage plans. Medicare will pay for medical care provided in a facility or adult day care but does not pay for personal care services or assistance with activities of daily living .9 These are the average 2020 monthly costs for nursing homes and other outsourced care:11
- Home-based care: $4,481-$4,576
- Nursing home : $7,756
- Nursing home : $8,821
Don’t Miss: Is Pneumonia Shot Covered By Medicare
The Spousal Impoverishment Act
While long-term care costs for a declining loved one must be considered, one must also think about the costs of living and support for his/her spouse to live a comfortable lifestyle at home. Contained within Medicaid laws is the Spousal Impoverishment Act, which dictates how much in resources and assets one can live on should their spouse become sick and require care.
New Jersey refers to the spouse receiving care as the institutionalized spouse and the spouse remaining home as the community spouse. The law states that the community spouse may keep up to a maximum of $130,380. This is referred to as the Community Spousal Resource Allowance . The institutionalized spouse may keep $2,000/$3,000 under NJ Law.
Does Medicaid Cover Adult Day Care
Unlike Medicare, Medicaid will cover adult day care services and/or adult day health care services. Most states offer Home and Community Based Services Medicaid Waivers to seniors who have low income, few assets and a demonstrated need for skilled nursing care. These HCBS Medicaid Waivers provide services, such as adult day care, in-home care or care in an assisted living facility, that enable seniors to remain living in the community for as long as possible.
There may be a waiting list for supportive services like adult day care, depending on whether the state includes them in their basic Medicaid State Plan as an entitlement or uses a waiver program. Financial and functional eligibility requirements are unique to each state, but waiver programs typically have less restrictive financial guidelines and a cap on how many people can be served.
Medicaid coverage of adult day health care usually requires a health assessment and a physicians order before a senior can be admitted into the program. These centers often provide rehabilitative physical, occupational and speech therapies, and staff include a registered nurse , therapists and other health professionals. Specialized adult day care services for eligible seniors with dementia are also covered by Medicaid.
Don’t Miss: Does Medicare Cover Any Weight Loss Programs
Types And Costs Of Alzheimers Care
Prior to a discussion of the financial resources available to assist individuals stricken with Alzheimers, it is helpful to understand the different types of Alzheimers and dementia care, how they differ from regular home care or assisted living, and what these services typically cost. The following information is current for year 2019.
Alzheimers Care at Home
Most home care providers do not charge higher fees for individuals with Alzheimers. Rather, they have a flat rate for home care services and a slightly higher rate for home health care services. Depending on ones state, as of 2019, this figure ranges from $16 to $28 / hour with a national average of $21 / hour for home care services. Home health care is just slightly higher ranging from $16 to $30 / hour and a national average of $21. See each states average home care costs.
the tendency for individuals with dementia to leave the home and become lost presents a challenge for Alzheimers caregiving at home. In residential care, security prevents wandering. But until fairly recently, private residences did not have this option. Now there are internet / smartphone products for real-time location monitoring which can reduce wandering and the cost of caring for loved ones at home. Learn more.
Alzheimers Care in Senior Living / Assisted Living Residences
Alzheimers Care in Nursing Homes
Alzheimers Care at Adult Day Care Centers
Cost of Alzheimers Medications
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
Also Check: How To Choose Best Medicare Part D Plan
Tax Credits Or Refunds
The Tax Credit for the Elderly or the Disabled allows adult children of people with Alzheimers or another dementia to claim their parent as a dependent, helping families save thousands of dollars on income taxes. The Child and Dependent Care Credit may also apply to qualifying families. In addition, people may be able to deduct the cost of memory care or home modifications from their taxes.
Does Medicare Cover Memory Care
For some people, memory and cognitive function can begin to decline with age. Most people think that this a completely normal part of getting older, but in reality, mental function should stay constant throughout a persons older adult life. If you or a loved one suffers from or is starting to show signs of memory decline, you may be wondering what types of care options are available through Medicare insurance.
What is Memory Care?Memory care is a specific type of treatment that is provided to individuals that have been diagnosed with Alzheimers disease, dementia, or other memory issues. This type of care involves having a highly monitored environment with set routines and schedules to help reduce the effects of memory decline and confusion.
Memory care facilities provide safe, stress-free environments for their community members. They also carry out many programs to help improve cognition and slow its decline. Some of these programs can be related to nutrition while others may be based on physical tasks, such as fitness exercises or memory games.
Do Medicare Benefits Include Memory Care?In most cases, memory care facilities are not covered by Medicare. Because of this, placing a family member in a memory care facility can be quite expensive. However, there are certain types of care that Medicare does provide that can be beneficial during the early, middle, and late stages of mental decline and memory loss.
Also Check: Do You Have Dental With Medicare
Senior Life Insurance Policies
Some senior life insurance policies can be exchanged for Alzheimers care. Certain life insurance policies may be sold for a lump sum, which allows you to receive monthly payments. Some life insurance policies can also be converted into months or years at a residential care facility.
If you have a policy that builds cash value inside it, which basically means that it has a savings account inside of it, then an individual may be able to do a couple of different things to use those resources for long-term care, says Ash.
If you decide you no longer want the death benefit, you could cash out, or cancel, the policy and use the money to pay for memory care. Another option may be to take out a policy loan, says Ash. You use some money to pay for long-term care, but if its not all used, the rest remains a death benefit for beneficiaries. Be sure to talk with the insurance company or their agent about possible impacts to the policy, so you make an informed decision about whether or not this is a good idea for you.
A life insurance, long-term care hybrid policy is becoming more and more popular, says Ash. Many people have bought policies that have a death benefit as well as long-term care features.
If you have a life insurance policy and need ways to pay for memory care, check on the specific details with your insurance company. Many have special provisions that may help you afford memory care.
At What Point Do Dementia Patients Need 24 Hour Care
Early Alzheimers sufferers have difficulty controlling their movements as their symptoms progress. In addition to 24-hour supervision, they require round-the-clock care. Despite their disabilities, they share their pain even with others, and they are more likely to become ill when the disease hits them.
Also Check: What Is New With Medicare
Allow Me To Educate You On The Topic Of Long
When caring for someone who requires long-term care, it is essential that you educate yourself on the topic of planning for that care and government benefits and programs that can help pay for that care. Trust me, some basic knowledge of the subject can save you a lot of money and time.
By consulting with a knowledgeable Elder Care attorney, you can familiarize yourself with Medicaid, the Veterans Aid and Attendance Benefit, and other government financial assistance programs created to help you and your loved one. If eligible, these programs can help offset all or a significant portion of your medical and long-term care expenses. Allow me to teach you some of the legal solutions that exist to help you avoid emptying your bank account for the care of a loved one. Please call me, Fredrick P. Niemann, Esq., an experienced NJ Elder Care & Medicaid Lawyer today, toll-free at 376-5291 or email me at . Im here as a resource to you and to answer your questions when we meet.
Learn More About Medicare
Join our email series to receive your free Medicare guide and the latest information about Medicare and Medicare Advantage.
TTY 711, 24/7
Plan benefits may vary and may not be available in all locations.
Call to speak with a licensed insurance agent who can help you determine your eligibility to enroll and find Medicare Advantage plans in your area that offer dementia care benefits at 1-800-557-6059TTY Users: 711, 24/7.
Recommended Reading: Does Humana Medicare Cover Tdap Vaccine
How Can I Get Help Paying For A Caregiver
If you or your loved one have exhausted your financial resources paying for in-home caregivers, you may be eligible for both Medicare and Medicaid.
Every state has at least one home- and community-based health services waiver program. If you meet the eligibility guidelines, this type of waiver program could help you pay for things like:
- adult day care
- help with daily personal care
- modifications to your home
- help with housekeeping
If you think you or someone in your family might need custodial care, you may want to consider a long-term care insurance policy to help you cover the cost.
A Medicare supplement plan may also help you pay some of the costs that Medicare wont cover.
Can Medicare Supplement Plans Help
If youre looking at your Medicare options, you may have heard of Medicare Supplement plans. These plans, also known as Medigap, can seem like a promising way to get additional coverage to supplement Original Medicare.
However, this isnt quite the case. Medigap plans cover out-of-pocket costs associated with Medicare, like your coinsurance fees. There are various Medigap plans out there, but none of them will actually provide additional medical coverage. Although these plans can be useful in general, they dont specifically help with home health care in any way.
Also Check: Will Medicare Cover A Lift Chair
Options To Help Pay For Alzheimers Care
Original Medicare pays for some costs associated with Alzheimers disease, but there are also some insurance options that could help with care-related expenses.
- Some Medicare Advantage plans often offer coverage that Original Medicare does not, such as home health services, transportation to and from doctor appointments, and adaptations to your home. But not all extra benefits are available with all Medicare Advantage plans.
- Long-term care and disability supplemental insurance plans can also help with Alzheimers costs, depending on the plan. You must be enrolled in one of these supplemental plans prior to a diagnosis.16
- Some life insurance policies will allow you to borrow a policys cash value or offer accelerated death benefits.16
Talk with a licensed health insurance agent about which options would work best for you and your familys needs.
Does Medicare Pay For Adult Day Care
Medicare alone does not pay for any of the kinds of adult day care mentioned above. However, Medicare Advantage Plans that are sold by private insurance companies typically offer expanded coverage compared to Original Medicare , which is administered directly by the Centers for Medicare & Medicaid Services . Certain Medicare Advantage Plans may provide partial coverage for adult day care services, but they are not required to do so.
Read Also: How Does Tricare For Life Work With Medicare