Introduction
As you and your family evaluate your long-term care needs for dealing with Alzheimer’s disease, it is important to consider financing options including health coverage, Medicare, and Medicaid. Long-term financial planning is important for everyone — but is essential if you are coping with the expense of a long-term illness, such as Alzheimer’s disease. Many people pay careful attention to their health after they are diagnosed with Alzheimer’s. They research their treatment plan, take their medications on schedule, and consult with their physician regularly. However, it may take some time for patients and caregivers to realize that a progressive illness like Alzheimer’s can have a tremendous effect on their financial well-being.
This article offers some basic information on how to handle your finances while living with Alzheimer’s disease.
Developing a Plan
Alzheimer’s disease gets worse over time, and dealing with a progressive illness is difficult. There is no way to know how you will feel or what you will be able to do days, months, or years from now. But for your own security and that of your family, you need to plan ahead, knowing that Alzheimer’s disease will lead to increasing disability. There are professional financial managers and medical lawyers who deal with financial planning for people with long-term or progressive illnesses. Ask your doctor for a referral, or speak with a national association or support group to find a reputable professional in this area.
Medical Coverage
- If you are insured, either through your employer or a retirement policy,
read all of the policies pertaining to long-term/progressive illnesses. If you
are unsure about the language or terminology, contact the personnel department
or your financial planner. - If you are unemployed and you do not have coverage, you should look for the
highest level of coverage that you can afford. The Alzheimer’s Association may
be able to give you a list of insurers with a high level of Alzheimer’s
coverage. - If you are 65 or over, you qualify for Medicare. You can supplement this
insurance with a “Medigap”
policy available through a private insurer. Note also that many states have
prescription assistance/reimbursement programs for low-income senior
citizens. - If you are disabled but too young to qualify for Social Security, you may
be eligible to receive a form of Medicare for the disabled. - If you cannot get insurance and your income is low, you may qualify for
Medicaid, a government “safety net” program that pays for medical costs that
exceed a person’s ability to pay.
Investigate Long- and Short-term Disability Insurance
Check to see if your employer has private disability insurance, and contact
your human resources department to investigate your eligibility, the cost of
enrolling, and how much of your salary it will cover.
- If you are unable to continue working.
- If you are too young to qualify for Social Security, you should consider
state-run disability programs, unless you are enrolled in your employer’s
disability coverage. - If your total income is below a certain level, you may qualify for
federally subsidized Supplemental Security Income (SSI). If you collect SSI,
regardless of your age, you are a candidate for Medicaid.
Medicare and Medicaid
What Is Medicare?
Medicare is a federal
health insurance program providing health care benefits to all Americans age 65
and over, as well as some disabled individuals under age 65. Eligibility for
Medicare is linked to Social Security and railroad retirement benefits.
Medicare has co-payments and deductibles. A deductible is an initial amount
you are responsible for paying before Medicare coverage begins. A co-payment is a percentage of
the amount of covered expense you are required to pay.
What Are Medicare’s Coverage Options?
Medicare has two parts:
- Part A (hospital insurance)
- Part B (medical insurance)
Part A Medicare coverage includes:
- All normal hospital services.
- Skilled nursing facility care.
- Home health services, including a visiting nurse or a physical,
occupational, or speech
therapist. - Medical supplies.
- Hospice services.
Part B Medicare coverage includes:
- Eighty percent of reasonable charges from doctors and other health care
professionals (after the annual deductible is met). - Medically necessary ambulance services.
- Physical, speech, and occupational therapy.
- Home health care services (physician certification is necessary).
- Medical supplies and equipment.
- Transfusion of blood and blood components provided on an outpatient
basis. - Outpatient surgery.
Part B Medicare benefits require that you pay a monthly premium. You must
also be entitled to Part A benefits to receive Part B benefits.
QUESTION
One of the first symptoms of Alzheimer’s disease is __________________.
See Answer
Medicare Coverage of Skilled Nursing Care Facilities
In order to receive care in a nursing home under
Medicare:
- You must have had a three-day hospital stay prior to admission into the
skilled nursing facility. - You must be admitted into the skilled nursing facility within 30 days of
discharge from the hospital. - You must enter the skilled nursing facility for treatment of the same
condition for which you were hospitalized. - You must require daily skilled care.
- The condition must be one that can be improved by admission to the
facility. - The facility must be Medicare-certified.
- Your physician must write a care plan. The care plan must be carried out by
the skilled nursing facility. (Once the patient meets the level of functioning
laid out in the care plan, Medicare will no longer pay for services.)
Medicare Coverage of Home Care
In order to receive home care under Medicare:
- The patient must be homebound.
- The physician must certify a plan of care.
- Care must be needed on a non-continuous basis.
- Care cannot exceed 35 hours per week or 8 hours per day.
- Physical or speech
therapy must be provided on a “necessary and reasonable” basis. There are no
restrictions on the number of days or hours per week of these therapies. - If a person qualifies for home health care, he or she is entitled to a home
health aide to provide some personal care.
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What Is Medicaid?
Medicaid is a joint
federal-state health insurance program providing medical assistance primarily to
low-income Americans. It also is available to people under 65 if they are blind
or disabled.
The purpose of Medicaid is to provide preventive, therapeutic, and
rehabilitative health services and supplies that are essential to attain an
optimum level of well-being.
How Do People Receive Medicaid Benefits?
There are two ways to receive Medicaid:
- Through Supplemental Security Income (SSI) — People who receive a cash
grant under SSI and Aid to Dependent Children are automatically eligible for
Medicaid benefits. - Medicaid spend down — This is similar to a deductible or a co-payment
that you must pay every month. Once you meet your “spend down” amount, you are
eligible for Medicaid for the remainder of the month.
Who Is Eligible for Medicaid?
Medicaid eligibility requirements depend on financial need, low income, and
low assets. In determining Medicaid eligibility, officials do not review rent,
car payments, or food costs. They only review medical expenses. Medical expenses
include:
- Care from hospitals, doctors, clinics, nurses, dentists, podiatrists and
chiropractors. - Medications.
- Medical supplies and equipment.
- Health insurance premiums.
- Transportation to get medical care.
Medicaid Coverage
Medicaid coverage varies from state to state. For specific coverage
guidelines, contact your state’s Department of Human Services. Generally,
Medicaid benefits include:
Transportation
- Ambulance services when other means of transportation are detrimental to
the patient’s health. - Transportation to and from the hospital at time of admission or discharge
when required by the patient’s condition. - Transportation to and from a hospital, outpatient clinic, doctor’s office,
or other facility when the doctor certifies the need for this service.
Ambulatory Centers
- Ambulatory health care centers are often private corporations or public
agencies that are not part of a hospital. They provide preventive, diagnostic,
therapeutic, and rehabilitative services under the direction of a doctor.
Ambulatory services covered by Medicaid include dental, pharmaceutical,
diagnostic, and vision care.
Hospital Services
- Inpatient hospital care.
- Private hospital rooms only when the illness requires the patient to be
isolated for his or her own health or the health of others. - Outpatient preventive, therapeutic, and rehabilitative services.
- Professional and technical laboratory and radiological services.
- Medical Supplies and Medications
- General medical supplies (when prescribed by a doctor).
- Durable medical equipment (such as hospital beds, wheelchairs, side rails,
oxygen administration apparatus, special safety aids, etc.). - Medications prescribed by a doctor, dentist, or
podiatrist.
Home Health Care
- Visiting nurse
- Home health aide
- Physical therapist
Skilled Nursing Facilities
- Skilled nursing facilities and intermediate care facilities (providing
short-term care for a patient whose condition is stable or reversible) are
covered through Medicaid with a physician’s authorization.
For More Information:
U.S. Department of Health and Human Services
Health Care Financing Administration
6325 Security Blvd.
Baltimore, MD 21207
(410) 786-3000
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