Dementia-Related Expenses: Exploring Insurance Coverage Options

Article Summary

This article provides an overview of the types of insurance that may cover dementia-related expenses.

Key takeaways:

1. Medicare may cover doctor visits, bloodwork, and prescription drugs, but not private in-home care.
2. Medicaid coverage varies by state, but may cover in-home health care, non-medical care, home modifications, and assisted living facility costs.
3. The Department of Veterans Affairs offers pension funds and the Aid and Attendance program to help cover expenses for veterans.

Introduction

Because dementia is a progressive health condition, your parent may eventually require care beyond doctor appointments and prescription medications. They may need at-home health services, non-medical home care, home modifications and/or admission to an assisted-living facility or memory-care center.

Will your parent’s insurance cover all of the services that they need? Will you need to contribute funds to care for them? A financial planner who specializes in eldercare or an elder law attorney should be able to answer questions about your parent’s specific situation. In the meantime, here are some basics which may help to guide your expectations regarding costs and coverage related to common dementia-related medical expenses

Medicare

If your parent has Medicare, it should cover doctor visits, bloodwork and prescription drugs. Once your parent needs additional care, it may not be helpful.

“They will pay for appointments, just like your other medical situations, [but] Medicare will not cover private, in-home care,” says Helen Justice, GCM, a certified geriatric care manager based in Roseville, California and principal at Advanced Wellness Geriatric Care Management.

If your parent needs a non-medical caregiver to help with activities of daily living, Medicare doesn’t cover those expenses. It also usually won’t cover at-home medical care, although there are exceptions.

“[If] they went into the hospital or skilled nursing for a period of time, they will get four to six visits from home health,” Justice says. “Medicare will pay for the six visits, to make sure you don’t rotate back into the hospital system.”

Medicaid

Medicaid coverage varies by state, but people who qualify are typically eligible for in-home health care and non-medical care, for assistance with daily tasks like bathing, dressing and eating. It may also cover home modifications and assisted living facility costs.

Whether or not your parent qualifies for Medicaid depends on their assets, income and medical expenses. Speak with a financial planner or elder law attorney early on, before you consider merging bank accounts with your parent, because your funds may affect their Medicaid eligibility.

Veteran programs

The Department of Veterans Affairs offers pension funds that may be used to cover expenses like non-medical in-home caregivers for veterans who meet certain criteria.

“If they’re paying for private in-home care, [they] could get a couple thousand dollars a month to help defray that cost,” Justice says. “That is only for wartime veterans and widows of wartime veterans.”

Homebound veterans – or those who live in nursing homes – who need help with activities of daily living may qualify for the VA’s Aid and Attendance program, which provides additional assistance.

Long-term-care insurance

If your parent doesn’t have long-term-care insurance, it’s unfortunately too late to get it. But if they have a policy, you can start using it.

“You need to be buying this in your late 40s, early 50s and paying on the premium all this time,” Justice says. “You will pay the premiums all the way until you start using it.”

Every policy is different, but long-term-care insurance may cover in-home health care, non-medical in-home care, home modifications, assisted living facilities and memory-care centers. Most policies cap out at a certain dollar amount. Read the fine print to see how much assistance your parent’s policy provides.

Personal savings

When no other options are available and there’s money in the bank, you or your parent may consider paying for in-home health care and non-medical care with your own funds.

“There’s times that adult children have to step up to the plate and subsidize the parents, out of their own retirement or their own pocket,” says Justice, who notes that a memory-care center may cost $7,500 per month. “It will devastate a family in a hurry.”

Talk to a financial planner or elder law attorney to see if other options may be available.

Author Bio

Lisa Fields is a passionate healthcare writer and advocate for better senior care in America. This article has been reviewed by TJ Falohun, co-founder and CEO of Olera. He is a trained biomedical engineer and writes about the cost of healthcare in America for seniors.