Medicare and Alzheimer’s Disease: Your Coverage Explained

What parts of Medicare cover Alzheimer’s disease?

Medicare covers all medically necessary services related to the prevention, diagnosis, and treatment of Alzheimer’s disease. Here’s a look at what each part of Medicare covers for Alzheimer’s.

Medicare Part A (hospital insurance)

Medicare Part A covers inpatient services related to Alzheimer’s disease, such as:

• short-term inpatient hospital stays
• therapies and medications needed during inpatient hospital stays
• short-term skilled nursing facility stays
• limited home healthcare services
• hospice care

Medicare Part B (medical insurance)

Medicare Part B covers outpatient care for Alzheimer’s disease, such as:

• screening and diagnostic services
• doctors’ and specialists’ appointments
• treatment-related services and care
• certain outpatient prescription drugs given by a medical professional
• physical, occupational, or speech therapy
• inpatient and outpatient mental health services
• necessary durable medical equipment
• ambulance services
• participation in certain clinical trials

Medicare Part C (Medicare Advantage)

Medicare Part C covers all Alzheimer’s disease services included under Original Medicare (parts A and B). Some Medicare Advantage plans also cover:

• prescription drugs
• dental, vision, and hearing services
• fitness and wellness services

Coverage of these services and any other additional healthcare perks depend on the plan you choose.

Medicare Part D (prescription drug coverage)

Medicare Part D helps cover medications you take at home to treat Alzheimer’s disease.

Every Medicare Part D plan must cover certain protected drug classes, such as antidepressants and antiretrovirals. However, coverage of additional drugs varies based on your drug plan’s formulary, which is a list of covered drugs.

Medicare supplemental insurance (Medigap)

Medigap helps cover some of the out-of-pocket costs charged by your Original Medicare plan. This may include:

• deductibles
• copays
• coinsurance
• other healthcare costs

Unlike Medicare Part D, Medigap plans don’t offer any additional healthcare coverage.

What services and treatments are covered for Alzheimer’s disease?

Here are each of the specific services and treatments related to Alzheimer’s disease that Medicare covers.

Doctors’ visits and testing

Alzheimer’s disease, like most forms of dementia, benefits from early diagnosis and treatment. Medicare covers both preventive and diagnostic services for Alzheimer’s disease, starting with yearly wellness visits and cognitive impairment assessments.

Medicare also covers:

• diagnostic non-laboratory tests
• diagnostic laboratory tests
• yearly depression screenings

These diagnostic tests and screenings can help detect early signs of Alzheimer’s disease and rule out any other underlying causes of cognitive decline. They can also be used to monitor Alzheimer’s disease progression.

As of October 2023, the Centers for Medicare & Medicaid Services (CMS) expanded coverage to include diagnostic use of PET scans for beta-amyloid protein, an important marker associated with Alzheimer’s disease. The Alzheimer’s Association encourages Medicare beneficiaries to see if scans are covered in their area.

Medicare Part B will cover any medically necessary services related to screening, diagnosing, and monitoring Alzheimer’s disease.

Medications

Previously, the Food and Drug Administration (FDA) had only approved prescription medications that help to mitigate the symptoms of Alzheimer’s disease. These included medications like cholinesterase inhibitors and memantine.

Cholinesterase inhibitors slow cognitive decline by increasing the levels of acetylcholine, a type of neurotransmitter, in the brain. Doctors often prescribe memantine with cholinesterase inhibitors to further decrease cognitive decline.

When used together, both medications may help decrease cognitive and behavioral symptoms of Alzheimer’s disease. Additional prescription medications like suvorexant and brexpiprazole can also treat Alzheimer’s-associated insomnia and agitation, respectively.

More recently, the FDA has approved monoclonal antibodies that directly target beta-amyloid. Examples of these include lecanemab and donanemab.

Medicare Part B may cover monoclonal antibodies for the treatment of early Alzheimer’s disease in some situations. Requirements include:

• a diagnosis of either mild cognitive impairment due to Alzheimer’s disease or mild dementia due to Alzheimer’s disease
• enrollment in a qualifying study or registry that aims to collect evidence on how well these drugs work

Medicare Part D will cover most of the prescription drugs used to treat the symptoms of Alzheimer’s disease, as long as the drugs are included in your plan’s formulary.

Services and therapies

People who have received a diagnosis of Alzheimer’s disease may experience both cognitive and behavioral changes. The following services can help manage these changes:

• physical therapy
• speech-language pathology services
• occupational therapy
• mental health services

Physical therapy is helpful for addressing the physical limitations that Alzheimer’s disease might cause, while speech therapy can help with the ability to communicate.

Occupational therapy and mental health services can improve overall quality of life, both physically and mentally.

Medicare Part B will cover any medically necessary services related to improving the symptoms of Alzheimer’s disease.

Durable medical equipment

In the later stages, Alzheimer’s can impair mobility.

Over time, it may cause difficulty walking or moving around. Durable medical equipment might be helpful. This might include:

• canes
• crutches
• lifts
• walkers
• wheelchairs

Medicare Part B will cover medically necessary durable medical equipment that you use at home.

Alzheimer’s coverage at a glance

Here’s a quick overview of some of the Medicare-covered items, services, and medications that may be necessary for Alzheimer’s care:

What isn’t covered for Alzheimer’s disease?

While Medicare covers a wide range of inpatient and outpatient services for Alzheimer’s disease, a service might not be covered in certain situations, including:

• Nursing home care: Medicare will not cover nursing home care if it’s the only care you require for Alzheimer’s disease. If you require around-the-clock custodial care, you will pay the full out-of-pocket cost.
• Off-label medications: Medicare covers certain medications only when they’re prescribed for an FDA-approved use. If your doctor decides to use a medication that’s not yet approved for Alzheimer’s symptoms, your prescription drug plan may not cover it.
• Skilled nursing facility care: Medicare covers short-term nursing facility care, which generally includes many of the services, medications, and other needs you would have in an outpatient setting. However, you’ll only be covered for up to 20 days at no cost. After that, you’ll owe a portion of the costs as coinsurance each day. If you spend more than 100 days in a skilled nursing facility, you will pay the full out-of-pocket cost going forward.

If you’re concerned that your plan won’t cover a service or medication, you can reach out to your doctor or insurance provider to check.

The takeaway

Alzheimer’s disease affects millions of people each year, many of whom are enrolled in Medicare.

Medicare coverage for Alzheimer’s disease is fairly comprehensive, covering everything from diagnostic testing to FDA-approved medications and more.

However, not all services for Alzheimer’s disease are included under Medicare, so check with your plan provider if you’re not sure whether something is covered.