Medicare Alzheimer's Coverage - Are Nursing Home Costs Covered?

Alzheimer's disease is a form of dementia that affects older adults. It is a progressive disease characterized by declining memory and cognitive ability. Although some medications may help to alleviate or delay the progression of symptoms, there is no cure.

According to a 2008 report released by the Alzheimer's Association, an estimated 5.2 million Americans currently suffer from the disease. It is the most common form of dementia, afflicting 1 in 8 persons over the age of 65.

Medicare, a federal health insurance that covers people age 65 and over, provides limited coverage for Alzheimer's patients.

Prior to 2002, all Medicare beneficiaries diagnosed with Alzheimer's had been automatically denied reimbursement on the grounds that the disease was incurable, and medical treatment was ineffective.

Thanks to a governmental policy change in 2002, Medicare no longer denies claims for mental health services, home health care, or hospice care for these patients.

However, Medicare coverage for the care of Alzheimer's patients is still restricted. Medicare does not cover assisted living, senior housing, adult day care, or long-term nursing home care.

Medicare Part A (Hospital Insurance) will pay a limited fraction of the cost of care in a skilled nursing facility, but only if several requirements are met. First, the patient must have been hospitalized for at least three days for a medical condition. Second, the patient must be admitted to the skilled nursing facility within 30 days of being discharged from the hospital. Third, the patient must be admitted to the skilled nursing facility for the same condition for which he or she was admitted to the hospital. If all of these requirements are met, Medicare will pay in full for only the first 20 days in the skilled care facility. Days 21 through 100 will require a co-payment of up to $128 per day, and after day 100, Medicare payments will cease altogether.

Coverage of home health care is similarly restricted. Medicare Part A may pay for up to 100 visits, but only if the patient is also covered by Medicare Part B (Supplemental Health Insurance). To qualify, the patient must have spent at least three days in a hospital or skilled nursing facility, and be discharged within 14 days of the start of home health care services. The patient must be confined to home under a physician's orders.

Hospice care is covered if the patient is terminally ill and expected to have less than 6 months to live. Medicare initially covers two periods of 90 days, followed by an unlimited number of 60 day periods.