Finding the right insurance – medical and prescription coverage

Getting setup with the right medical insurance can significantly reduce the financial burden of expenses related to treating dementia, ensuring access to necessary treatments without overwhelming costs.

Understanding Dementia Care Needs

• Comprehensive Coverage: Dementia care involves various medical needs, including regular doctor visits, medications, possibly specialized treatments, and long-term care. Ensure the insurance plan covers these aspects. Long-term care is the hardest one to cover – Medicaid and long term care insurance are typically the one insurances that will help cover the cost of this.

• Prescription Coverage: Dementia often requires specific medications. Check if the insurance covers these medications and what the out-of-pocket costs will be. Visiting online pharmacy delivery sites like Mark Cuban’s Cost Plus or Amazon Pharmacy can help considerably in reducing the cost of most medications and are worth checking out – just know that if you don’t use your insurance, then the cost of medications you buy through these pharmacies without insurance does not go towards your deductible or total out of pocket cost calculations.

• Specialist Care: Dementia patients may need to see neurologists or geriatric specialists. Ensure these specialist visits are covered.

Evaluating Insurance Options

• Medicare: For those over 65, Medicare is a primary option. Assess the different parts of Medicare:

• Part A covers hospital stays and some aspects of home health care and nursing home care.

• Part B covers doctor's visits and outpatient services.

• Part D for prescription drug coverage.

• Medicare Advantage Plans (Part C) often combine A, B, and sometimes D, with additional benefits.

• State Health Insurance Assistance Programs (SHIP): They offer free counseling and assistance to Medicare beneficiaries.

• Medicaid: If your loved one has limited income and resources, Medicaid might be an option. It can cover aspects of care that Medicare does not, including long-term nursing home care. Getting your finances in order so you can appropriately apply for Medicaid is critical to get done as early as possible. (see additional section on Medicaid for more details)

• Supplemental (Medigap) Policies: These can help cover Medicare copayments, deductibles, and other out-of-pocket costs.

• Visit HealthCare.gov to learn more on how to pick a health insurance plan that is right for your loved one with dementia

Financial Considerations

• Premiums, Deductibles, and Copays: Evaluate the costs associated with the insurance plan, including premiums, deductibles, and copayments.

• Out-of-Pocket Maximum: Understand the maximum amount you’ll have to pay out-of-pocket within a year.

Coverage Limitations and Exclusions

• Long-Term Care Coverage: Traditional health insurance and Medicare typically do not cover long-term custodial care. Look into long-term care insurance (which can be very expensive) or Medicaid as possible solutions.

• Coverage Restrictions: Be aware of any restrictions or limitations in coverage, such as limited days of care or pre-authorization requirements.

Planning for Progression

• Flexibility for Changing Needs: As dementia progresses, your loved one’s medical needs will change. Choose a plan that offers flexibility to adjust coverage as needed.

• Review Annually: Insurance needs may change annually, so review and adjust plans as necessary.

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