If you have a loved one with Alzheimer’s disease, you probably want to provide them with the best care possible. You might be wondering what types of care will be covered by Medicare and other health insurance plans, from in-home care to assisted living facilities to nursing homes. Or, maybe you want to know if your loved one’s Alzheimer’s prescriptions will be covered by your health insurance. While paying for long-term Alzheimer’s care can be expensive, the good news is that by planning ahead, you can budget for the costs and find the best insurance options for you. We’ll help walk you through all the answers you need when considering the costs of caring for your loved one with Alzheimer’s.
What are the common care costs for Alzheimer’s disease?
According to the Alzheimer’s Association, these are some of the most common types of costs you can anticipate when creating your loved one’s Alzheimer’s care plan:
- Ongoing medical treatment, including diagnosis and follow-up visits
- Safety-related expenses, such as home safety modifications or safety services for a person who wanders
- Prescription drugs
- Personal care supplies
Then, there are the different types of daily and long-term caretaker services, such as:
- Adult day care services
- In-home care
- Full-time residential care
The type of care that’s right for you will vary depending on your loved one’s situation, but at-home care services tend to be the preferred option for many Alzheimer’s patients. In their Cost of Care Survey, Genworth Life Insurance Company calculated the median costs for these long-term care services for seniors in 2020. These were their findings:
- In-home care with a non-medical health aide: $23 per hour and $1,012 per week.
- Adult day services: $75 per day.
- Assisted living facilities: $4,051 per month or $48,612 per year.
- Private room in a nursing home: $280 per day or $102,200 per year.
- Semi-private room in a nursing home: $247 per day or $90,155 per year.
Keep in mind that these figures are medians, so the actual numbers will vary depending on your geographic location and the level of care that is needed for your loved one. Clearly, the costs of long-term care services can add up quickly, so finding the right insurance to help pay for the costs is important.
Will insurance cover in-home and long-term care?
Long-term care for Alzheimer’s patients is surprisingly not covered by Medicare. At-home services might be provided on a limited basis, but only if there is a physical therapy need, not as general custodial care. Additionally, Medicare’s nursing home benefits are limited to 100 days. The program will cover 100% of the costs for the first 20 days if the care is deemed “medically necessary,” and 80% of the cost for the final 80 days.
Luckily, benefits offered in Medicare Advantage plans, a form of supplemental insurance for Medicare recipients, have been expanding greatly in the past few years. Medicare Advantage plans can help fill in coverage gaps for Alzheimer’s patients on Medicare by offering things such as adult day care, in-home care, and safety device installation (i.e. wheelchair ramps). TrueCoverage offers the software to help you find the Medicare supplemental insurance that’s right for you.
If you’re hoping to have insurance cover the costs of in-home care, purchasing private long-term care insurance is another option. It’s important to note that your loved one will not be able to apply for this type of insurance if they’ve already been diagnosed with Alzheimer’s. If you already have a plan in place, check to make sure that Alzheimer’s is one of the types of care that is covered – it usually is!
It’s also important to check what types of caregivers are covered under these plans. Some plans will cover any non-family member caregivers; others might require you to use a licensed caregiver from an agency. Coverage for these types of plans is typically based on a daily benefit, so be sure to clarify what the benefit amount is on your specific plan. You don’t want to end up hiring a caregiver for hours that are not covered by your insurance.
For low-income patients, Medicaid does have more robust options for covering at-home Alzheimer’s care. According to Kiplinger, Medicaid is actually the primary payer of long-term care services for the elderly. In some states, this long-term care will only be administered in Medicaid-eligible nursing homes. However, other states have Medicaid coverage for at-home care and care in assisted living facilities. Medicaid will cover either all or a portion of long-term care costs, depending on your eligibility, but keep in mind, it is only available to those who meet a very low income threshold.
Does Medicare cover Alzheimer’s prescriptions?
If your loved one takes medication for their Alzheimer’s and does not already have a Medicare Part D plan, it’s important to enroll in one to reduce out-of-pocket costs. The costs of prescriptions could also be covered under your Medicare Advantage plan. While most Medicare Part D plans will cover Alzheimer’s drugs, your co-payments might vary depending on the plan. By searching on TrueCovering, you can find the best Medicare Part D plan for your loved one’s prescription needs.
Ultimately, the costs of caring for a loved one with Alzheimer’s disease can be much higher than costs for other elderly Americans. One study found that in their final years of life, elderly adults with Alzheimer’s disease had costs of roughly $18,000 more in total than those who did not have Alzheimer’s. Retirement plans, community support services, employee benefits, reverse mortgages, and life insurance conversions are some of the ways that people meet the financial demands of Alzheimer’s disease. And with the right insurance plan, you’ll be able to cut back on some of the long-term costs. Our insurance experts at TrueCoverage are ready to help support you every step of the way!