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Does Medicare Cover Dementia Testing?

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Maybe you are starting to notice that your mother doesn’t seem to be as sharp as she was in the past. Perhaps your father is repeatedly asking questions about something you have already talked about or has recently gotten lost on the way home from the gas station, even though he has been there a hundred times before. Whatever the case, you’re starting to get worried. No one’s memory is perfect but this seems different.

So, you want to have your parent evaluated, but does Medicare cover dementia testing? Medicare is required to cover a screening for cognitive impairment to be done during a participant’s annual wellness visits. This also includes testing for Alzheimer’s, which is the most common form of dementia.

The yearly Medicare benefit includes the creation of a personalized prevention plan and detection of possible cognitive impairment.” – Alzheimer’s Association

“This cognitive assessment should be part of every senior’s annual wellness visit,” said Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association, in a recent NPR article. This assessment only takes a few minutes and can include several components, including observing the person’s communication with others, using short written or verbal tests, or interviewing the patient or their family about any cognitive changes they may have noted.

Does Medicare Cover Cognitive Testing?

As the law stands now, primary care doctors who test patients for dementia can elect to bill Medicare for that cognitive assessment. This cognitive testing, called a Health Risk Assessment, is usually done during the senior’s annual wellness visit.

The doctor can also bill Medicare for the charges incurred for creating a Care Plan for a patient who is diagnosed with dementia. Medicare does not however, cover the cost of long term custodial care services for patients with dementia.

Should the senior need diagnostic testing, Medicare will cover 80% of the cost of CT scans, MRIs, and PET scans if they are requested by the person’s primary care physician. These scans take images of the person’s brain, which will show any abnormalities that might cause cognitive changes.

No single test can tell if someone has dementia or Alzheimer’s. Instead, testing for the cognitive changes that accompany these diseases consists of:

  • Taking a thorough medical history
  • Testing a patient’s mental status
  • Doing a comprehensive physical and neurological exam
  • Conducting blood tests
  • Taking comprehensive brain images, such as MRI’s or CT scans

Early diagnosis of dementia and putting a proper care plan in place is crucial. With these things addressed, it can result in fewer hospitalizations, better medication management, and a better quality of life for those with this condition.

Medicare Annual Wellness Memory Test

In January, 2011, the Affordable Care Act created the Medicare Annual Wellness Visit, which should be completed during a patient’s annual checkup after joining Medicare. This Annual Wellness visit provides preventative health services and also focuses on detecting any form of cognitive impairment in the patient. The test should only take about five minutes to complete.

A cognitive impairment test is searching for any sign of short term memory impairment, which is a common trait of those who are in the early stages of dementia – most notably Alzheimer’s disease. The test can also include evaluation of planning and reasoning skills (known as executive functioning).

During the Medicare Annual Wellness Visit, the senior’s primary care doctor will perform either a paper or online test, or may use a combination of both. Doctors tend to prefer to use the online test as it is typically more accurate.

Here are a few reasons someone should be tested, according to the Alzheimer’s Association:

  • Individuals with memory concerns or other cognitive complaints. Non-memory triggers include personality change, depression, deterioration of chronic disease without explanation, and falls or balance issues
  • Informant reports of cognitive impairment, with or without patient concurrence
  • Medicare beneficiaries, as part of the Annual Wellness Visit​​

The Alzheimer’s Association also notes that the benefits of testing include:

  • Better chance of benefiting from treatment
  • More time to plan for the future
  • Lessened anxieties about unknown problems
  • Increased chances of participating in clinical drug trials, helping advance research
  • An opportunity to participate in decisions about care, transportation, living options, financial and legal matters
  • Time to develop a relationship with doctors and care partners
  • Benefit from care and support services, making it easier for the person and their family to manage the disease

In other words, if you or a loved one are on Medicare and are noticing symptoms, such as memory loss, ask your primary care doctor to perform a cognitive test. The symptoms could be something as simple as exhaustion and stress, but if it is something more, catching a cognitive impairment early can help slow the progression of the disease.

Does Medicare Require Memory Tests?

While Medicare does not require someone to take a memory test, it is highly recommended that an individual gets screened, particularly if they are over age 65. Remember, however, that even if someone takes the test and happens to do poorly on it, their loss of memory or inability to remember things in the short term can be caused by other factors that were not being addressed prior to the test.

These are many reasons that a memory test should be performed annually. Sadly, the reality of the situation is that those who are diagnosed with any form of dementia have usually been living with the disease for about 3-5 years before their diagnosis.

Cognitive (memory) testing can benefit a senior citizen in two main ways:

  1. It increases their physical safety and allows for better quality of life decisions. Having regular checkups and getting annual cognitive evaluations can help the senior develop a plan of care early, if a diagnosis shows that they will need specialized care in the future. This also reduces the risk of someone making a serious or fatal error when it comes to managing their medications or accidentally hurting themselves in their home.
  2. Ability to react to newer treatment options: Advances in treatment have shown great promise in extending someone’s normal cognitive function by several years for those in the early stages of dementia. Aside from the inherent benefit of improving one’s quality of life, they also have the benefit of reducing the health care costs that are associated with dementia and Alzheimer’s.

Medicare Cognitive Test Questions

The Medicare Cognitive Test is an examination to test one’s memory function, particularly their short term memory. It is a 30 question test that asks relatively simple questions such as: “What is the month?” or “What year is it?” This exam is the one that is generally used to help screen for dementia.

The test can also be used to get an estimate of the severity and progression of an individuals’ cognitive impairment and to track the changes in someone’s cognitive performance over time. Additionally, it is an effective way of tracking an individual’s response to treatment.

The test questions are not designed to trick the person in any way. They are only being used to determine whether or not someone potentially has dementia, and if they do, to help decide the best course of action to take in their treatment.

If you have concerns about yourself or a loved one, talk to your (or their) primary care doctor. While the Medicare Annual Wellness Test should be done as part of your annual checkup, if you are worried about memory problems, rest assured that you do not need to wait a year to ask for a cognitive examination. Call your primary care doctor and ask them to set up an appointment to talk to them about your concerns.

What Is A Medicare SNP?

Did you know that Medicare has plans that will cover people with certain special needs (dementia is one of these)? They are called Medicare SNPs and are a type of Medicare Advantage Plan that is similar to an HMO or PPO. Medicare SNPs are limited to people with specific diseases or characteristics, including:

  • Autoimmune disorders
  • Cancer (excluding pre-cancer conditions)
  • Cardiovascular disorders
  • Chronic alcohol and other dependence
  • Chronic and disabling mental health conditions
  • Chronic heart failure
  • Chronic lung disorders
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
  • HIV/AIDS
  • Neurologic disorders
  • Severe hematologic disorders
  • Stroke

Also, people who live in an institution, such as a nursing home or memory care facility, or those who require at home care, or those who have both Medicare and Medicaid fall under these plans.

Keep in mind that each SNP limits its membership to people in one of these groups, or a subset of one of these groups. To illustrate, an SNP that accepts individuals with dementia will only accept someone if they have dementia, but won’t take them if the person has diabetes, but not dementia. That person would have to be accepted by an SNP that covers diabetes.

A Medicare SNP covers the same services as regular Medicare, but also covers additional services that are specific to that group (so, an SNP for people with chronic heart failure would get to see a specialist and would have their heart medications covered).

Who Qualifies For SNP?

In addition to having one of the conditions listed above, a senior must also:

  • Have Medicare Part A coverage (hospital)
  • Also have Medicare Pat B coverage (medical)
  • Live in the plan’s service area

A senior can stay enrolled in a Medicare SNP only until they no longer meet the conditions of qualification. So, if they were covered within a Medicare SNP that limits enrollment to those with both Medicare and Medicaid, for example, and they lost their Medicaid eligibility, they would no longer be eligible for that particular SNP either. There is a one month grace period (some plans have a longer grace period) to try to keep their eligibility. The senior also would have another two-month special enrollment period to try to qualify for coverage again.

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