Quick Guide to Dementia

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.

Quick GuideCaring for Someone With Alzheimer's Disease

Caring for Someone With Alzheimer's Disease

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:

  1. Part A (hospital insurance)

  2. 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.

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.

Quick GuideCaring for Someone With Alzheimer's Disease

Caring for Someone With Alzheimer's Disease

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:

  1. Through Supplemental Security Income (SSI) -- People who receive a cash grant under SSI and Aid to Dependent Children are automatically eligible for Medicaid benefits.

  2. 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

WebMD Medical Reference

WebMD Medical Reference Reviewed by Jon Glass on 16, 2009

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Reviewed on 6/16/2009
References
WebMD Medical Reference Reviewed by Jon Glass on 16, 2009

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