New Medicare Coverage for Individuals With Alzheimer's Disease

This past November 2016, The Centers for Medicare & Medicaid Services (CMS) finalized a decision for Medicare to pay for cognitive and functional assessments and care planning for patients with Alzheimer's disease and other cognitive impairments. This makes it easier for physicians to provide critical care and support services for persons living with Alzheimer's disease.

Specifically, Medicare will now reimburse primary care doctors who conduct an Alzheimer's evaluation and offer information about care planning to elderly patients with cognitive impairments. Testing for Alzheimer's disease can involve taking a thorough medical history, testing a patient's mental status, doing a comprehensive physical and neurological exam, and conducting blood tests and brain imaging. Previously, there was no specific Medicare reimbursement for dementia testing, so doctors did not take the time to do it.

In addition, Medicare will reimburse doctors if they help Alzheimer's patients with care planning by providing information on treatments and services.

Why has Medicare decided to pay for such services? Receiving early diagnosis and proper care planning is critical for Alzheimer's patients. It can result in fewer hospitalizations, fewer emergency room visits and better medication management. This helps manage overall care costs and improves the quality of life for patients and caregivers.

The National Alzheimer's Association worked very hard to get Medicare to provide this needed service.

However, this new rule for dementia testing does not expand Medicare's limited benefit for covering long-term care costs. Medicare does not pay for custodial care in nursing homes or in the home. It's skilled nursing care benefit is limited to 100 days after a 3 day stay in a hospital. In addition, the patient must receive daily physical or occupational therapy and be certified that such care is needed by the patient.

More than 5 million Americans are living with dementia today. That number could rise as high as 16 million by 2050. Over 85 percent of people with Alzheimer's and other dementias have one or more other chronic conditions, such as diabetes or heart disease. Care planning is critical for coordinating care and managing chronic conditions.

Edward Zetlin Law is experienced in Elder Law and Special Needs Planning issues. Don't hesitate to call if you face such an issue or if you have additional questions. Edward Zetlin Law would be happy to discuss. Please contact us at 703-379-0442 or e-mail at

Community Presentations in April 2017. Mr. Zetlin will be presenting at St. Coletta of Greater Washington, on April 8th at Noon. He will discuss Guardianship and Special Needs Planning.

Contact us at (703)379-0442;

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