Age-related memory loss is common, but more severe memory problems generally is a sign of dementia, which will not be a standard a part of aging.
“Dementia is a set of symptoms that present as cognitive changes of sufficient severity to interfere with your daily activities, your daily functions, so that your thinking abilities prevent you from doing what you used to do,” says Ronald C. Petersen, MD, PhD, director of the Mayo Clinic Alzheimer’s Disease Research Center and the Mayo Clinic Study of Aging in Rochester, MN.
Dementia is on the rise within the USA. 14 million cases are expected by 2060. Alzheimer’s is essentially the most common type of dementia and represents 60-80% of all Diagnoses. According to the Alzheimer’s Association, about 6.9 million Americans In 2024, people aged 65 and over were affected by Alzheimer’s disease, which is 10.9% of those over 65.
Alzheimer’s, which affects memory and considering skills, occurs when Amyloidsnaturally occurring proteins within the body, clump together and form amyloid plaques within the brain.
Other forms of dementia that affect people over 65 are Lewy body dementiabrought on by abnormal deposits of the protein alpha-synuclein, often called Lewy bodies, vascular dementiabrought on by diseases that damage the blood vessels within the brain or interrupt the provision of oxygen and blood to the brain, and mixed dementiaa mixture of no less than two forms of dementia.
Dementia patients have quite a lot of medical problems. “In addition to the symptoms associated with dementia, the vast majority of dementia patients have one or more chronic diseases,” says Matthew Baumgart, vice chairman of health policy on the Alzheimer Association.
Medicare (and Medicare Advantage) offer some coverage for dementia, starting at diagnosis, Baumgart says.
Diagnosis of dementia
The annual Medicare wellness visit, which is free for Medicare beneficiaries, includes cognitive evaluations. If the doctor has concerns, chances are you’ll be referred to a specialist or must see your doctor again for a clinical evaluation to find out if you will have cognitive impairment. This appointment is roofed by Medicare Part B and a copayment and/or deductible may apply.
During the exam, “a doctor will take the patient’s medical history as well as someone who knows the person well to determine if there has been a change in memory, thinking, behavior or function,” Petersen says. “The doctor will also perform a mental status examination, which may include exercises where the patient is asked to remember words, do calculations, say the name of the current president, draw a box, etc., to get a rough estimate of a person’s cognitive function,” he says. “If needed, the doctor may perform additional cognitive tests to more closely examine memory, attention, language and visual-spatial skills. Then all of this information is compiled and an assessment is made,” Petersen says.
Care planning for dementia
Once diagnosed with dementia, patients can live for a few years, Petersen says. Symptoms will worsen over time, he says, which is why it is important to create a care plan.
The Alzheimer’s Association has been a robust advocate for Medicare coverage of dementia care planning, and since 2017, Medicare Part B has covered the price of a self-directed visit to a health care provider or specialist to create a care plan for people diagnosed with dementia.
A Care plan for dementia patients may include beneficial treatments and therapies for dementia symptoms and other health conditions, safety recommendations, care support, end-of-life planning, and more.
Medicines against dementia
Although there is no such thing as a cure for any type of dementia, medications can relieve symptoms and/or prevent further cognitive decline.
All Medicare drug plans must cover no less than two forms of prescribed drugs which might be considered Cholinesterase inhibitors. These medications treat Alzheimer’s disease by improving memory, attention, considering, and language, and by increasing levels of chemicals within the brain that aid memory and judgment.
In 2023, lecanemab, sold under the brand name Leqembi, was approved by the FDA to treat mild cognitive impairment and mild Alzheimer’s disease. “The drug is infused intravenously into the veins, circulates in the blood, goes to the brain and activates the immune system to remove some of the amyloid plaques from the brain,” says Petersen.
Leqembi is roofed by Medicare Part B, provided that a PET scan has confirmed the presence of amyloid plaques within the brain and that the patient is on a RegistrationThe registry is a set of real-world evidence concerning the effects of medicines submitted by doctors through a nationwide portal.
The cost of the PET scan, if used specifically to diagnose this disease, is covered by Medicare Part B, starting at the tip of 2023. Before this decision, Medicare only covered cerebrospinal fluid tests for which a Lumbar punctureto detect amyloid plaques within the brain. Copayments for diagnostic tests under Medicare are generally 20% of the price, after the annual deductible.
In July 2024, donanemab, sold under the brand name Kisunla, received FDA approval. It can also be an intravenous drug and covered by Medicare with a PET scan confirmation of amyloid plaques within the brain and the inclusion of the patient in a registry.
Both Leqembi and Kisunla are covered by Medicare Part B, meaning Medicare beneficiaries don’t must enroll in Medicare Part D to get these prescriptions covered. Insured individuals still must pay the 20% deductible, and each drugs are expensive. The manufacturer’s stated cost for Leqembi is $26,500 per yr. The manufacturer’s stated 12-month treatment cost for Kisunla is $32,000.
The Inflation Reduction Act of 2022 could provide some relief. Starting in 2025, the law will cap out-of-pocket costs for Part D drugs at $2,000.
Medicare coverage of dementia-related long-term and private care
“Unfortunately, Medicare does not cover some important services for people with dementia, including long-term care and personal assistance,” Baumgart says. Long-term care includes stays in assisted living facilities, adult day care and nursing home stays of greater than 100 days, he says. Personal assistance includes help with activities of each day living, including meal preparation and help with bathing and dressing.
“Medicare provides skilled nursing home care for certain skilled therapies such as physical, occupational or speech therapy or occasional skilled nursing care,” Baumgart says. A physician must certify that the patient is homebound and desires this help, and it should be provided by a Medicare-approved home care agency, he says.
If a dementia patient has insurance through each Medicare and Medicaid, Medicaid may pay some or all the services not covered by Medicare. Medicaid can also pay some or all the Medicare premiums, copayments, and deductibles.
“Medicare covers the end stage of dementia – hospice care,” says Baumgart.
A brand new program that helps dementia patients
The government has two initiatives that may boost efforts to supply additional help to dementia patients. These include the one announced by the Biden administration in April 2023 Implementing Regulation 14095 to enhance access to high-quality care and to support caregivers and National Plan to Combat Alzheimer’s Disease,
A program that meets each criteria is the GUIDE modelwhich launched as a Medicare pilot program on July 1, 2024.
“We are excited about it,” says Baumgart. “It offers dementia patients and their caregivers the opportunity to navigate the health and social care system more smoothly,” he says.
The program provides additional Medicare coverage for care coordination and care management, caregiver training and support, and respite services.
More Medicare:
