MEDICARE AND MEDICAID BENEFITS

Medicare does not differentiate Alzheimer’s and dementia care from other chronic medical conditions such as Chronic Obstructive Pulmonary Disease (CODP) or Congestive Heart Failure (CHF). Instead, Medicare has policies about when and how much it will pay for care. Typically, Medicare pays the following:

  • Medicare will pay for 100% of the first 20 days of the cost of nursing home care when medically necessary
  • Medicare pays for 80% of the cost of an additional 80 days of care (days 21 -100)
  • If an individual with Alzheimer’s requires care in a psychiatric hospital, Medicare increases the number of days of paid assistance up to 190 days.
  • Medicare does not pay for personal care at home or in assisted living and its nursing home benefits are limited to 100 days.
  • Medicare Supplementary Insurance does not specifically provide additional benefits for Dementia patients however it does offer supplemental assistance. Policies usually pay 20% of the cost of nursing home care not paid for by Medicare

Medicare does not pay for Home Care aka “custodial” or “personal care” provided in an assisted living or skilled nursing facility but will pay for medical care provided in that location.

Medicaid, Home & Community Based Service (HCBS) Waivers and Alzheimer’s Care

medicare medicaid benefitsMedicaid is a state and federally funded health insurance program for low income families and the elderly. All states are responsible for the administration of their Medicaid programs, consequently every state offers different benefits associated to the care for individuals with Alzheimer’s or dementia.

Medicaid Waivers are state programs that allow individuals to receive care outside of nursing homes. Medicaid Waiver participants can receive care in their homes, communities and sometimes in assisted or senior living residences which is paid for by Medicaid.

  • Most Medicaid Waivers have both financial eligibility requirements and requirements that the participant have functional limitations.
  • Very few, require a specific diagnosis of Alzheimer’s or dementia instead they consider one’s ability or inability to care for themselves by accessing their ability to perform their activities of daily living.
  • From a functional perspective, mid to late stage Alzheimer’s patients typically qualify for Medicaid benefits quite easily.

Top-Rated Home Care and Support for Dementia & Alzheimer’s Patients

Dementia Helpers offers specialized home care and support services to Alzheimer’s and dementia patients throughout Chicago and the North Shore suburbs including both Cook County and Lake County. We provide our in-home dementia care and specialized memory care services to residents of Arlington Heights, Buffalo Grove, Chicago, Deerfield, Des Plaines, Evanston, Glencoe, Glenview, Grayslake, Gurnee, Highland Park, Fort Sheridan, Highwood, Kenilworth, Lake Bluff, Lake Forest, Libertyville, Lincolnwood, Lincolnshire, Morton Grove, Niles, Northbrook, Park Ridge, Round Lake Beach, Skokie, Vernon Hills, Wilmette and Winnetka.

We are backed with the resources of one of America’s largest and most trusted home care service organizations.