Alzheimer’s disease is the most common form of dementia. An estimated 6.9 million Americans are currently living with Alzheimer’s and as the population ages, these numbers will continue to grow. Along with the impacts to physical and emotional well-being, the financial repercussions of Alzheimer’s cannot be understated. It is one of the most expensive diseases in America, costing more than cancer and heart disease.
Considered a serious public health issue, The National Institutes of Health has been allotted more than $3.8 billion for Alzheimer’s research in 2024 with additional funding requested for 2025. This funding will help with the expedited development of effective treatments and preventive measures.
Here’s what you need to know about this disease, the promising new treatments, and what Medicare will cover.
Do Your Genetics Put You at Risk?
If you have a family history of Alzheimer’s, it does not mean you will develop it too. But having a first degree relative such as parent or sibling with the disease does increase your risk. Researchers have discovered a number of genes that are linked to Alzheimer’s. The most common gene found is APOE (apolipoprotein E), but not everyone who has this gene develops Alzheimer’s. Researchers found that some individuals who carry this gene also carry an Alzheimer’s resistant variant that helps prevent the buildup of amyloid plaques in the brain. Amyloid plaques are abnormal protein deposits and are a defining characteristic of Alzheimer’s disease. Researchers hope this exciting discovery may lead to therapeutic treatments that will enhance genetic resilience to the disease.
Importance of Early Diagnosis
There is no known cure for Alzheimer’s, and it is difficult to diagnose. Changes to the brain can begin as much as 20 years before any symptoms appear. This means early detection is critical for early intervention and treatments.
There are many diseases and conditions that can mimic the same symptoms and are often misdiagnosed as Alzheimer’s. These conditions may be treatable and in some cases the symptoms can be reversed. These include:
- Conditions of the liver such as cirrhosis
- Depression
- Untreated sleep apnea
- Side effects of certain medications
- Lyme disease
- Thyroid disease
- Head injury
- Blood clots or tumors within the brain
- Certain vitamin deficiencies such as B-12
- Excessive alcohol consumption
Individuals with these undiagnosed conditions often end up unnecessarily tying up much needed resources for Alzheimer’s patients, delaying treatment for everyone. Better diagnostic tools would help alleviate this issue.
One exciting new diagnostic tool is a simple blood test that can be used to diagnose mild cognitive impairment during the early stages of Alzheimer’s. It was found to be 96% accurate in identifying elevated levels of beta amyloid and up to 97% accurate in identifying p-tau217, a protein associated with damage to the brain caused by Alzheimer’s. The manufacturers of the test have received Breakthrough Therapy designation from the FDA which will help expedite regulatory approval and bring the test to market more quickly.
What Medicare Covers
Medicare will cover some care related to the diagnosis and treatment of Alzheimer’s as well as some medications to help manage the disease. While we’ve included a general guide regarding coverage below, always check with your carrier before incurring costs. Coverage may vary by insurer and your specific Medicare plan.
Diagnosis and Treatment
Medicare typically covers ongoing hospital care, doctor visits, and some tests used to diagnose Alzheimer’s such as PET scans (Positron Emission Tomography) which are a critical tool in diagnosing Alzheimer’s in its early states by identifying abnormal amounts of beta-amyloid protein in the brain. It may also cover mental health services and medical equipment and supplies if they are needed to live at home and are ordered by your doctor.
Coverage for out-of-pocket expenses such as deductibles, copays and coinsurances are determined by the type of Medicare coverage the individual has, such as a Medicare Advantage plan, Original Medicare, or a Medicare Supplement plan.
Prescription Drugs
Medicare may also cover some prescription drugs related to the treatment of Alzheimer’s. There are two categories of drugs aimed at treating the symptoms related to memory and thinking. These are Cholinesterase Inhibitors and Memantine. Every insurance carrier is required to cover at least two drugs in each of these two categories. These medications are covered under Part D prescription drug coverage and out of pocket costs will vary based on the plan.
New Alzheimer’s Medications
Some of the most promising developments in treating Alzheimer’s has been with the development of new medications. These FDA approved treatments work by reducing the amount of beta amyloid in the brain, slowing the progression of the disease. They are for those in the early stage of the disease diagnosed with mild cognitive impairment. These drugs include Aduhelm (aducanumab), Leqembi (lecanemab), and Kisunla (donanemab). These drugs are not a cure, and do not restore memory loss that has already occurred.
These medications are currently only available to patients who are seeing a qualified physician participating in a CMS approved registry. The registries are designed to collect real world information on the effectiveness of the drugs. The medications are costly. Because they are injected in a doctor’s office or other health care setting, they may be covered under Medicare Part B benefits. Medicare beneficiaries may be responsible for as much as 20% of the cost, depending on their Medicare coverage.
Even though these drugs have received FDA approval they remain controversial and offer mixed results. Side effects include headaches, nausea, fever, chills, and in some cases more serious side effects are experienced such as swelling of the brain and bleeding in the brain.
What Medicare Does Not Cover
Medicare does not cover any experimental treatments or therapies that have not received FDA approval, unless they are part of an approved clinical trial.
Medicare does not cover stays longer than 90 days in a nursing home and does not cover long term custodial care which is defined as care to help with activities of daily living such as eating, dressing, bathing, mobility, and toileting. This often comes as a surprise to Medicare beneficiaries and their families and creates a financial burden that many cannot afford.
Reducing Your Risk
While your genetics and family history cannot be changed, the good news is some risk factors can be managed in order to reduce your risk of cognitive decline and developing Alzheimer’s. A 2022 study found that eight modifiable risk factors were associated with 36.9% of Alzheimer’s and dementia cases:
- Hearing loss
- Current smoking
- Diabetes
- Depression
- Midlife hypertension
- Low education
- Physical inactivity
- Midlife obesity
While we hopefully await the arrival of new Alzheimer’s treatments, we can choose to be proactive in managing our health and reducing our risk factors by staying physically active, eating a healthy diet, and maintaining a healthy weight.
Silver&Smart is a convenient source for Medicare information. Sign up for our free news alerts and visit often.