Medicare vs Medicaid

If your loved one has been diagnosed with Alzheimer’s or dementia, navigating through health insurance, Medicare and Medicaid can be a difficult process. Almost half of nursing facility residents suffer from some form of dementia and about one in five have progressive declining cognitive function and memory loss. And those with Alzheimer’s disease or dementia often have complex medical and behavioral health needs that require the assistance of a caregiver in order to attend to routine daily activities. Nearly all adults with dementia receive Medicare benefits. However, Medicare does not pay for long-term care – aside from 100 days skilled services or rehabilitative care for a qualified stay.

Medicare Part A: 

  • Pays for hospital costs after you pay a standard deductible
  • Pays for short stays in a nursing home for certain kinds of illnesses
  • Pays for hospice care in the last 6 months of life

Medicare Part B:

  • Pays partial fees for doctor’s services, outpatient care, and other medical services not covered by Part A
  • Pays for some preventive services – including diabetes screening and flu shots

Medicare Part D:

Pays for some medication costs

For information about Medicare benefits, visit, or call 1-800-633-4227, TTY: 1-877-486-2048 

Not all those with Alzheimer’s disease qualify for Medicaid. 

Medicaid is a program jointly funded by federal and state governments. It is administered by each state. You’ll want to find out what your state’s criteria is for Medicaid and start planning well in advance of when your loved one might need Medicaid coverage. Some memory care patients qualify for Medicaid through an age (65+) or disability-related pathway – if they can demonstrate a low income and limited assets. 

Some states expand Medicaid eligibility to people that will require an intensive level of care but have incomes and assets above the established limit.

There patients are required to criteria for functional eligibility – requiring help with daily activities like:

  • Bathing
  • Dressing
  • Cooking
  • Eating
  • Managing medications

Other Insurances

Group Employee Health Plan or Retiree Medical Coverage

If your loved one is under 65 years old and has been diagnosed with early-onset Alzheimer’s private insurance, a group employee health plan or retiree medical coverage may help pay for some expenses.

Long-Term Care Insurance

You must already have a long-term care policy in place prior to diagnosis. Once you have an Alzheimer’s disease diagnosis, it will be difficult to obtain long-term care coverage, since most policies include strict pre-existing condition clauses.

Disability Insurance

Disability insurance provides income for a worker who can’t work due to illness or injury. However, this type of insurance plan has to be in place before symptoms of Alzheimer’s disease appear. 

COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985)

If your loved one with Alzheimer’s is younger than age 65 and still working, COBRA may be an option to continue health care coverage. However, COBRA must be activated within 60 days of when the person with dementia receives written notice from his or her insurer that COBRA is an option. An employee may continue health care coverage for up to 18, 29 or 36 months under COBRA, depending on the circumstances. 

Life Insurance

You may be able to borrow from a life insurance policy’s cash value. Or the person with dementia may be able to receive a part of the policy’s face value as a loan. 

Medigap Insurance

Another option to consider is Medigap insurance. It can help pay for the gaps in cost that Medicare coverage doesn’t pay – similar to coinsurance.

Non-profits & Foundation Assistance

The Alzheimer’s Foundation of America (AFA)

The Alzheimer’s Foundation of America (AFA) provides Family Respite Care Grants through funding local, non-profit, member organizations. These organizations work directly with the families to administer the grants. 

The Alzheimer’s Association (AA)

The Alzheimer’s Association (AA) has a Respite Grant Program that is administered by the local chapters. 

The National Family Caregiver Support Program (NFCSP)

The National Family Caregiver Support Program Depending on your loved one’s needs, services can involve in-home care, adult daycare centers or overnight residential facilities. (NFCSP) grants are administered on the local level by the Area Agencies on Aging Network.

Other Options

Social Security

Social Security Disability Insurance (SSDI) provides workers younger than age 65 Social Security disability payments. In order to qualify, your loved one must meet the definition of disability as established by the Social Security Administration. This involves proving that your loved one with dementia isn’t able to work in any type of job and the condition is expected to last least a year.

Through the Compassionate Allowance Initiative, those with younger-onset (also known as early-onset) Alzheimer’s disease are considered eligible for SSDI as long as they meet all other criteria. They also are fast-tracked to a favorable decision, which significantly shortens the time it takes to start receiving benefits. 

Supplemental Security Income (SSI) 

In order to qualify for SSI benefits, the person with Alzheimer’s must meet the Social Security Administration’s definition of disability. SSI provides a monthly income for people who are age 65 or older, or who are disabled or blind – provided that they have limited income and assets.

Veterans Benefits

Veterans with Alzheimer’s or dementia are eligible for a complete range of VA health care services including:

 Caregiver support is also an essential part of these services covered through veteran’s benefits.

State Programs

The MyCare Ohio Plan (MCOP) enrolls seniors into both Medicare and Medicaid—offering a single point of contact to access care services. Some of the services provided include:

  • Doctor visits
  • Medical transportation
  • Meal delivery services
  • Assistance with home modifications
  • Personal care services

If you end up paying for out-of-pocket, you may be eligible for tax credits and deductions:

 The AARP offers a Tax-Aide program providing tax preparation and counseling information free of charge for low and middle-income taxpayers, even if you’re not an AARP member.

State and Area Agencies on Aging

State and area agencies on aging provide information on programs that may help with the care of an individual with Alzheimer’s, including a wide range of local supports and legal services. 

State Departments of Health and Social Services (DHSS)

State Departments of Health and Social Services can provide information on statewide and local programs — including respite programs and services that may include financial assistance.

Copeland Oaks Is Here For You

Most seniors will eventually need help with daily living routines — bathing, dressing meal preparation, shopping, getting to appointments and more. And many busy families are simply not prepared to provide this level of care for the older family members in their lives. If your loved one is regularly confused, depressed, or has stopped managing their life, even with the help of assisted living, it may be time to make the transition. Memory care environments and care options, like you’ll find at the Copeland Oaks’ Donald R. James Assisted Living Memory Care Wing, are carefully and thoughtfully developed to assist seniors with a memory loss disease, like dementia and Alzheimer’s disease. Plan a visit to Copeland Oaks, we’d be happy to offer a tour. Call 330.938.1093.