For families with a loved one diagnosed with Alzheimer's related dementia's certified Alzheimer's / memory care facilities provides a safe and pleasing home environment. These specialized memory care communities are designed exclusively for individuals diagnosed with Alzheimer's disease and other types of memory impairments.
People with Alzheimer's disease require regular medical care as well as some special care that might include medications or other interventions. Medical services are often covered under medical insurance (either Medicare or private health insurance). It may be important to examine the health coverage to determine the extent of coverage limitations or co-pays and deductibles.
Traditionally, Medicare does not cover the costs of memory care or long-term care facilities. However, Medicare will cover qualified healthcare costs while your loved one is living at a certain facility. Medicare is more often used to pay for a skilled nursing facility or home health care.Private Health Insurance
Memory care is extremely expensive. The cost of care varies widely, depending on the services available and the facility’s specialization. On average, a private room in a memory care facility in the United States costs approximately $5,745 per month.
If the person with Alzheimer's has private health insurance it is important to contact the insurer and learn what lifetime maximums or other limitations you may encounter. Knowing what you are covered for in advance will help avoid surprises when coverage is denied.
Medicaid for Dementia / Alzheimer's Care
For most persons with Alzheimer’s or dementia, normal assisted living communities cannot provide adequate support. Instead, these communities have “memory care” wings (often a secured floor) or are standalone memory care residences. In almost every state, Medicaid will pay for some care in assisted living / memory care residences.
However, an important distinction must be made. Medicaid, by law, is prohibited from paying for the cost of room and board or “rent” for its beneficiaries who reside in assisted living residences. Rather, Medicaid can pay for their cost of care in those residences. In very ballpark terms, half of the monthly cost of memory care goes toward “rent” and the other half towards the care the residents receive.
In most states, care in assisted living / memory care is covered by an assisted living Medicaid waiver. Some states also offer personal care assistance through their regular Medicaid program. In these states, the law generally does not put restrictions on the location in which personal care can be provided. To clarify, the care recipient would be receiving “personal care”, but instead of living at home, they would receive that care in their primary place of residence, which happens to be a memory care residence.
Longtermcare.gov provides an overview of the Medicaid program and a link to state-based Medicaid resources.
Programs for Veterans
The Alzheimer's Association® can connect you with low-cost or free community support services. Call our 24/7 Helpline at 800.272.3900 (TTY: 866.403.3073). Benefits Check-Up helps you find benefit programs that can help pay for medications, health care, food, utilities and more.
Elder Options of Texas
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DISCLAIMER: Links to other websites or references to products, services or publications do not imply the endorsement or approval of such websites, products, services or publications by Elder Options of Texas. The determination of the need for senior care services and the choice of a facility is an extremely important decision. Please make your own independent investigation.