(LifeWire) -- Alzheimer's is a frightening disease, but wondering how to pay for Alzheimer's care can be even more frightening, especially when one must seek answers by navigating through the U.S. healthcare system.
But actually, there are real options, such as Medicare, Medigap, disability insurance (private insurance and insurance available from the Social Security Administration) and long-term care insurance to help families dealing with Alzheimer's disease handle the associated costs.
Medicare
More than 42 million Americans are enrolled in the Medicare insurance program. Medicare provides government-funded insurance coverage to people older than 65 years of age and those with disabilities who qualify. In most cases, Medicare covers 80% of nonhospital care and 100% of hospital care after the individual meets a deductible. People interested in enrolling should visit the Centers for Medicare and Medicaid Services website or contact their local Medicare office by calling (800)-MEDICARE.
According to the Fisher Center for Alzheimer's Research Foundation, Medicare coverage will "include 'reasonable and necessary' doctor's visits; physical, occupational or speech therapy; psychotherapy or behavioral management therapy by a mental health professional; and skilled home-care services" for qualifying patients with Alzheimer's disease.
Many people, however, still require a supplement to Medicare coverage. This type of coverage is commonly provided by a private insurance carrier and is referred to as "Medigap" insurance coverage.
Medigap
Medigap is a "secondary" insurance that can be added to one's Medicare coverage. It is sold by private health insurance brokers nationwide.
Federal and state laws outline what Medigap policies are required to cover, including the deductible associated with a hospital stay, the coinsurance or remaining hospital costs not covered by Medicare and, according to the Fisher Center for Alzheimer's Research Foundation, "the first three pints of blood that may be required for surgery or medical care." Some plans will offer more extensive coverage, including some in-home services coverage and assisted-living deductibles.
If you are interested in this kind of insurance, you should carefully consider the coverage options of each plan before enrolling. If you or a loved one needs help, consider using the government's health plan comparison website.
Disability Insurance and SSDI
Disability insurance may sound like a great option for people facing Alzheimer's disease; however, most insurers will only accept new plans prior to any type of diagnosis. If an individual already has prior coverage, though, either through an employer or a private insurance company, the policy will generally pay between 45 and 65% of a person's salary if he or she is unable to return to work.
If you or a loved one with Alzheimer's disease does not have disability insurance, you may qualify for the U.S. government's Social Security Disability Income. According to the Social Security Administration, a disability is defined as follows:
- The individual is completely disabled and cannot work at all.
- The individual cannot do other work because of the disability.
- The disability has lasted at least six months and is anticipated to last for at least one year.
Benefits will vary greatly by individual, according to the Social Security website. To learn more about the program visit the U.S. government's website for people with disabilities.
Long-Term Care
It's important to carefully read private insurance policies to determine if the costs for long-term care will be covered. If not, it may be time to look into long-term care insurance.
However, if you or a loved one has already been diagnosed with Alzheimer's disease, an application for long-term health insurance will very likely be declined. Families with a strong history of the disease may be well advised to look into this sort of insurance ahead of time.
Long-term care insurance policies vary greatly, but they are designed to cover the costs of a nursing home or assisted living care. Nursing home costs for an individual with Alzheimer's disease can run between $42,000 and $70,000 annually, according to the Alzheimer's Association. These costs, along with medical care and prescriptions, can break the bank for families that aren't prepared.
Most people wait until they are older than age 60 before they purchase long-term care insurance, but according to experts, it may be beneficial to think about the coverage at a much younger age. Insurance premiums are based on the current health of the individual applying for coverage. According to the Fisher Center for Alzheimer's Research Foundation, nearly one in four people applying for long-term health insurance is declined coverage because of health issues.
A guide to purchasing long-term care insurance can be ordered through the website of the National Association of Insurance Commissioners.
Sources:
"Insurance Coverage." alz.org. 23 Aug. 2007. Alzheimer's Association. 22 Jun. 2008 .<http://www.alz.org/professionals_and_researchers_insurance_and_coverage.asp>.
"Long-Term Care Financing." alz.org. 15 Dec. 2006. Alzheimer's Association. 22 Jun. 2008 .<http://www.alz.org/join_the_cause_long_term_care_financing.asp>.
"Long-Term Care Insurance." alzinfo.org. 2008. Fisher Center for Alzheimer's Research Foundation. 22 Jun. 2008. <http://www.alzinfo.org/alzheimers-resources-long-term-care-insurance.asp>.
"Medicare." alzinfo.org. 2008. Fisher Center for Alzheimer's Research Foundation. 22 Jun. 2008. <www.alzinfo.org/alzheimers-resources-medicare.asp>.
"Medicare Supplemental Insurance." alzinfo.org. 2008. Fisher Center for Alzheimer's Research Foundation. 22 Jun. 2008 <http://www.alzinfo.org/alzheimers-resources-medicare-supplemental-insurance.asp>.
"Supplemental Security Income (SSI)." disabilityinfo.gov. 2007. US Government. 22 Jun. 2008. <http://www.disabilityinfo.gov/digov-public/public/DisplayPage.do?parentFolderId=168>.