A: One of the best sources of information about Medicare’s coverage of Alzheimer’s disease, is the Alzheimer’s Association. I found the Alzheimer’s Association’s web site at http://www.alz.org to contain far more information than Medicare’s web site at http://www.medicare.gov and Medicare’s print materials.

Recently, the government reversed a long-standing policy regarding Medicare coverage of Alzheimer’s disease. According to an article in “The New York Times,” the new policy means that Medicare patients cannot automatically be denied reimbursement for the costs of mental health services, home health care, or hospice care simply because they have Alzheimer’s. In the past, about 20 of 50 Medicare contractors that process claims had computer systems that automatically denied payment of claims related to Alzheimer’s patients. As a result, Medicare beneficiaries in certain parts of the country were covered for certain services while those living elsewhere were denied.

The new policy should make it easier for Alzheimer’s patients to receive benefits that may previously have been denied. The government, however, gave no public notice of the new policy, and as I discovered, provides few specifics about coverage. The new policy was adopted after two years of lobbying by the Alzheimer’s Association and the American Bar Association’s Commission on Legal Problems of the Elderly.

The Alzheimer’s Association, through its Medicare Advocacy Project, has drafted the following excellent information for Medicare beneficiaries:

• Original Medicare: An Outline of Benefits
• Frequently Asked Questions About Fee-for-Service Medicare for People with Alzheimer’s Disease
• Fact Sheet on Medicare Denials
• Medicare’s Hospice Benefit for Beneficiaries with Alzheimer’s

The information is online at http://www.alz.org, or contact The Alzheimer’s Association, 919 North Michigan Avenue, Suite 1100, Chicago, IL 60611-1676, (800) 272-3900, (312) 335-8700, Fax: (312) 335-1110. 

For more information, read “Government Changes Rules on Alzheimer’s Coverage” at http://www.tscl.org/NewContent/101519.asp.

September 2002