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 about your family members. No one’s memory is perfect but this seems different.
You’d like to get them assessed, but that might be expensive. Are you curious to know if Medicare has your back when it comes to covering the costs of dementia testing?
In this guide, we’re going to talk about Medicare’s recent game-changing decision to step up and provide coverage for dementia testing. For many people, this means they can afford to get an assessment and possible start treatment sooner than before.
Medicare Part B covers diagnostic tests, including those for cognitive impairment and dementia, when they are deemed medically necessary by a healthcare provider. However, certain conditions must be met, such as having a face-to-face evaluation and receiving a written order from a qualified healthcare professional. Consult with your healthcare provider to understand the specific requirements and coverage details under Medicare for dementia testing.
The yearly Medicare benefit includes the creation of a personalized prevention plan and detection of possible cognitive impairment.”Alzheimer’s Association
This assessment is a quick test. It only takes a few minutes and can include several components.
These include observing the person’s communication with others and the use of short questionnaires or verbal tests.
The tester may also interview the patient or their family about any cognitive changes they may have noted (for example, a decline in visuospatial skills can be a warning sign of dementia. A simple clock drawing test is a good test to check for this type of decline).
“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.
Types Of Dementia Testing Covered By Medicare
Medicare covers various diagnostic tests and screenings for dementia to aid in detecting cognitive impairment.
Here are some commonly covered types of dementia testing:
- Mini-Mental State Examination (MMSE): MMSE is a widely used screening tool that assesses cognitive functioning. It involves a series of questions and tasks to evaluate memory, attention, language, and other cognitive domains.
- Montreal Cognitive Assessment (MoCA): MoCA is another cognitive screening tool that assesses various cognitive domains, including memory, attention, language, and visuospatial abilities. It provides a more in-depth evaluation compared to MMSE.
- Neuropsychological Testing: This comprehensive assessment involves a series of standardized tests administered by a neuropsychologist. It assesses multiple cognitive functions, such as memory, attention, language, executive function, and visuospatial skills.
- Imaging Studies: Medicare may cover brain imaging tests like magnetic resonance imaging (MRI) or positron emission tomography (PET) scans. These scans help evaluate brain structure, detect abnormalities, and aid in diagnosing certain types of dementia, such as Alzheimer’s disease.
- Laboratory Tests: Medicare covers blood tests to identify potential underlying causes of cognitive impairment, such as vitamin deficiencies, thyroid problems, or metabolic disorders.
It’s important to note that the specific tests and screenings covered by Medicare may vary, and coverage is typically based on medical necessity and recommendations from healthcare professionals.
The effectiveness of these tests in detecting cognitive impairment depends on various factors, including the individual’s symptoms, medical history, and the expertise of the healthcare provider administering the test.
Consulting with a healthcare professional is essential to determine which tests are appropriate and covered by Medicare based on an individual’s specific situation.
Memory Matters: Exploring Medicare’s Coverage For Cognitive Testing
As the law stands now, primary care doctors who provide dementia screening can elect to bill Medicare Part B 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 Dementia Care Plan for a patient who is diagnosed with dementia.
Medicare does not however, cover the cost of long term custodial care services for dementia patients.
Should the senior need diagnostic testing, Medicare pays 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.
To get enough evidence to make an accurate diagnosis, testing for the cognitive changes that accompany these diseases consists of such things as:
- 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 amyloid PET scans, MRI’s or CT scans
Early diagnosis of dementia and putting a proper care plan in place for future needs 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.
Annual Wellness Check: Is Your Memory Test Covered By Medicare?
In January, 2011, the Affordable Care Act health law created the Medicare Annual Wellness Visit, which should be completed during an older adults annual checkup after joining Medicare.
This Annual Wellness visit provides preventative health services for Medicare patients 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 online diagnostic tests as they are 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 decline or impairment, with or without patient concurrence
- Medicare beneficiaries, as part of the Annual Wellness Visit
The Alzheimer’s Association also notes that additional 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 trials for new prescription drugs to treat the condition, thus helping to 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 receiving Medicare benefits 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.
Unveiling The Requirement: Does Medicare Demand Memory Tests?
While Medicare does not require someone to take a memory test, it is highly recommended that older people get 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 test should be performed annually in the primary care setting.
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:
- It increases their physical safety and allows for better quality of life decisions. Having regular checkups and getting annual cognitive evaluations can help with early detection. The senior can 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.
- 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’s Mind Games: Essential Questions About Cognitive Testing
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 during the later stages of dementia.
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 a separate visit to talk about your concerns.
Medicare SNP Demystified: What It Means For Your Dementia Coverage
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 (Special Needs Plans) and are Medicare Advantage Plans that are similar to an HMO or PPO.
Medicare SNPs are restricted to people with a limited income or to those who have specific diseases, medical conditions, 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
- Diabetes mellitus
- End-stage liver disease
- End-Stage Renal Disease (ESRD)
- Neurologic disorders
- Severe hematologic disorders
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, individuals enrolled in an SNP for people with chronic conditions, such as chronic heart failure, would get to see a specialist and would have their heart medications covered).
Who’s In? Qualifying For A Medicare SNP And Dementia Testing Coverage
In addition to having one of the conditions listed above, a senior must also:
- Have Medicare Part A coverage (hospital)
- Also have Medicare Part 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.
The Process Of Obtaining A Dementia Testing Order
Navigating the process of obtaining a dementia testing order from a healthcare professional involves several key steps. Here’s guidance on how you can proceed:
- Schedule a Visit: Make an appointment with your primary care physician or a healthcare provider who specializes in cognitive health. Explain your concerns about cognitive impairment and the need for dementia testing.
- Face-to-Face Evaluation: During the appointment, your healthcare provider will conduct a face-to-face evaluation to assess your cognitive function and determine if dementia testing is necessary. They will ask you questions about your medical history, symptoms, and any difficulties you may be experiencing.
- Discussion and Recommendation: Based on the evaluation, your healthcare provider will discuss their findings with you. If they believe dementia testing is warranted, they will provide a written order for the specific tests or screenings needed.
- Obtain the Written Order: Request a written order or prescription for dementia testing from your healthcare provider. This document should include the specific tests to be performed and any additional information required for Medicare coverage.
- Insurance Coverage and Documentation: Contact your Medicare provider to confirm coverage for the recommended dementia testing. Inquire about any specific documentation requirements, such as the need for a prior authorization or additional forms to be completed.
- Follow Medicare Guidelines: Ensure that the recommended tests and screenings comply with Medicare’s guidelines for coverage. Medicare typically requires tests to be deemed medically necessary and ordered by a qualified healthcare professional who is a Medicare-approved provider.
By following these steps, individuals can navigate the process of obtaining a written order for dementia testing.
Remember to communicate openly with your healthcare provider, ask questions, and understand the documentation and coverage requirements specific to your Medicare plan.
Frequently Asked Questions
How often does Medicare cover dementia testing?
Medicare recipients can get tested for dementia once a year.
Are there any out of pocket costs for dementia testing?
Medicare coverage for dementia testing includes certain costs, but it’s important to be aware of potential out-of-pocket expenses. While Medicare Part B covers a significant portion of the costs, individuals may still be responsible for deductibles, copayments, or coinsurance. If you have supplemental insurance, that plan may help with these expenses.
Can I get dementia testing covered under Medicare Advantage (Part C) plans?
Medicare Advantage plans must provide at least the same coverage as Original Medicare (Part A and Part B). Therefore, dementia testing should be covered under Medicare Advantage plans, but specific coverage details may vary. Contact your plan provider for more information.
Are there any age restrictions for Medicare coverage of dementia testing?
Medicare coverage for dementia testing is not restricted by age. As long as you meet the eligibility criteria for Medicare, you should have access to the coverage for dementia testing.
Does Medicare cover genetic testing for dementia risk?
Traditional Medicare generally does not cover genetic testing for dementia risk assessment, as it is considered not medically necessary. However, there may be specific circumstances where genetic testing is warranted, such as in cases of early-onset or familial dementia. Consult with your healthcare provider to determine if genetic testing is appropriate for your situation.