- Dementia screening and testing may involve physical exams, laboratory and non-laboratory tests, cognitive assessments, and psychiatric evaluations.
- Medicare Part B covers most dementia testing, including wellness visits, depression screenings, and brain scans.
- Additional Medicare offerings can help cover other services, medications, and costs associated with dementia testing.
Dementia is a term used to describe several medical conditions characterized by cognitive decline. Dementia can negatively affect thinking, memory, language, judgement, and even behavior.
If you’re enrolled in Medicare and require dementia testing, your plan will cover wellness visits, depression screenings, and other tests your doctor may want to order.
Read on to learn more about which tests are used to diagnose dementia, as well as which parts of Medicare cover dementia testing.
Does Medicare cover dementia testing?
According to the National Institute on Aging (NIA), there are two elements of dementia screening:
- checking for underlying medical conditions, such as nutrient deficiencies or medication side effects
- testing for cognitive decline through physical examinations, cognitive assessments, and brain scans
Medicare generally covers all the services that are used during dementia screening and testing, including:
- annual wellness visits
- cognitive impairment assessments
- yearly depression screenings
- diagnostic non-laboratory tests
Which parts of Medicare cover dementia testing?
Medicare offers various types of coverage, from hospital insurance to prescription drug coverage, and more. Let’s explore which Medicare parts cover dementia testing.
Medicare Part A, also known as hospital insurance, covers inpatient hospital care, skilled nursing facility care, home health care, and hospice care.
Dementia testing is usually performed in an outpatient setting, such as at a doctor’s office or health clinic.
However, some dementia services and testing may be performed during an inpatient hospital stay. In this case, Part A may cover some of these expenses before Part B kicks in.
Medicare Part B, also known as medical insurance, covers:
- preventative, diagnostic, and treatment-related care
- limited prescription drugs
- durable medical equipment (DME)
- mental health care
Most dementia testing is considered preventative and diagnostic care, meaning that it’s covered by Part B. There are three areas of dementia testing that Part B covers:
- annual wellness visits, including cognitive impairment assessments to diagnose dementia
- yearly depression screenings
- diagnostic non-laboratory
Part C (Medicare Advantage)
Medicare Part C, also known as Medicare Advantage, covers all Medicare Part A and Part B services. Some Medicare Advantage plans also offer additional coverage, including:
Any dementia testing services mentioned above that are covered under original Medicare will also be covered under Medicare Advantage.
Medicare Part D, also known as prescription drug coverage, helps cover the costs associated with prescription drugs.
While outpatient prescription drugs generally aren’t used for dementia testing, most drugs used in the treatment of dementia are covered under Part D.
Be sure to check your drug plan’s formulary for more information on which medications are covered.
Medicare Supplement (Medigap)
Medigap, also known as supplemental insurance, helps cover original Medicare costs. These costs may include deductibles, coinsurance, copayments, and more.
Medigap doesn’t offer coverage of dementia testing. However, it may help cover some of the out-of-pocket costs associated with those tests. If you need help covering Medicare costs, you can compare plan offerings here.
What are the requirements for Medicare to cover dementia testing?
If your doctor is concerned that you may be developing dementia, any services that are considered medically necessary to diagnose your condition should be covered by your Medicare plan.
Medicare will cover everything from short-term hospitalization to preventative visits and diagnostic tests, as long as the service providers you choose accept Medicare.
If you’re concerned that a service or test may not be covered by your Medicare plan, reach out to your doctor or plan provider to check.
Finding help if your loved one may have dementia
A diagnosis of dementia can be difficult to process, but there is support available to help you throughout treatment and beyond.
The Alzheimer’s Association has some helpful resources for individuals with dementia and their loved ones, including:
- Helpline. Their 24/7 helpline can be reached at 800-272-3900. This free helpline offers education, support, and other resources for family members of individuals living with Alzheimer’s.
- Support Groups. They offer both individual and caregiver support groups. These nationwide support groups are offered both in-person and virtually.
- Education. They also have a virtual library that features education on the different types of dementia, especially Alzheimer’s disease.
What is dementia testing?
If your doctor or care team believes that you may be showing signs of dementia, there are a variety of tests that they can perform.
Generally, dementia testing includes:
- physical examinations to gather vitals, check balance, test reflexes, and determine any other accompanying physical symptoms
- laboratory tests to check for hormones, vitamins, and other important chemicals that may be associated with symptoms of dementia
- cognitive or neuropsychological assessments to determine the level of cognitive function or decline
- brain scans, such as CT, MRI, or PET scans, to rule out or identify any changes in the brain that are causing dementia symptoms
- psychiatric evaluations to determine if another mental health condition, such as depression or anxiety, is causing symptoms of cognitive decline
Although your primary care doctor can diagnose dementia, they may want to consult with a team of specialists to confirm your diagnosis. This may include consulting with geriatric specialists, neurologists, and neuropsychologists.
How much does dementia testing cost?
Out-of-pocket costs for dementia testing can vary, as your doctor will ultimately decide which tests are necessary for your diagnosis.
Here’s a glance at what those costs may look like both with and without Medicare.
Although Medicare covers almost all services associated with dementia testing, there are still costs associated with your plan that you may owe out-of-pocket. These can include:
- $0-$458 for the Part A premium
- $1,408 for the Part A deductible
- $0-$704+ for the Part A coinsurance
- $144.60 for the Part B premium
- $198 for the Part B deductible
- 20 percent of the Medicare-approved amount for the Part B coinsurance
- variable plan costs for the Part C premium and deductible
- variable coinsurance or copayment costs for prescription drugs needed during testing
- variable plans costs for the Medigap premium
Unless you have a Medigap plan that covers your plan deductibles, these amounts must be paid up-front first before Medicare will pay out for any dementia testing.
Without Medicare or another health insurance plan with similar coverage, you will likely have to pay for 100 percent of the costs of your dementia testing.
While annual wellness exams can be quite affordable, the more costly options — such as brain scans — can cost hundreds or thousands of dollars.
What is dementia?
Dementia is the loss of cognitive and behavioral functioning due to changes in the healthy neurons of the brain. People with dementia often have trouble with things such as memory, language, focus, and more.
Dementia can cause a person to have trouble functioning, and as the illness progresses, a person may become unable to care for themselves at all.
Dementia can present differently based on the types of changes in the brain. There are four different types of dementia:
- Alzheimer’s disease is the most common type of dementia. It’s generally diagnosed after the age of 65 and is considered a chronic, degenerative condition. Alzheimer’s can be mild or can progress rapidly. While there’s no cure for the disease, treatment can help slow cognitive decline and improve quality of life.
- Vascular dementia is the second most common type of dementia. This type of dementia happens when blood flow to the brain is reduced. The level of impairment with vascular dementia depends on the severity of the stroke or damage to the blood vessels. Like Alzheimer’s, treatment can help with symptoms and quality of life.
- Lewy body dementia is a type of dementia characterized by the presence of Lewy bodies, or abnormal proteins, in the brain. This type of dementia can occur either on its own or as a symptom of Parkinson’s disease. In addition to cognitive problems, Lewy body dementia can also cause hallucinations and motor problems. Even with treatment, this disease is still considered progressive.
- Frontotemporal dementia is an umbrella term for conditions that affect the frontal and temporal lobes of the brain. Frontotemporal dementia can cause behavioral and personality changes, speech and behavioral changes, or recall and speech changes. Treatment generally involves medications and lifestyle interventions to help reduce symptoms and slow progression.
The fifth type of dementia, called mixed dementia, occurs when two or more types of dementia are present.
Is there a treatment for dementia?
Dementia is considered a progressive condition, meaning that there’s no cure. However, medications, lifestyle changes, and alternative therapy may help slow the progression of the disease and increase overall quality of life.
There are currently two types of medications that have been approved to treat the symptoms of Alzheimer’s disease: cholinesterase inhibitors and memantine.
Cholinesterase inhibitors can help to delay or prevent the symptoms of dementia from worsening. They work by increasing a chemical in the brain called acetylcholine, which is linked to cognitive function.
Memantine can help to delay symptoms of cognitive decline in more moderate to severe Alzheimer’s disease. It also works on chemicals in the brain related to cognitive function and is often used in conjunction with cholinesterase inhibitors.
While these medications haven’t been approved to treat non-Alzheimer’s dementia, you and your doctor may choose to try them as off-label treatments.
The symptoms of dementia can cause a host of behavioral symptoms. The severity of some of these symptoms can be addressed through lifestyle changes.
Perhaps the most important aspect of dementia treatment is adequate emotional and physical support. This may include regular visits with therapists, doctors, and specialists to help manage daily symptoms.
Depending on disease progression, it may also include having a trusted full-time caregiver.
Nutrition and sleep are two elements of dementia care that should also be carefully handled. Proper nutrition can help ensure that all nutrient needs are being met, and adequate sleep can help reduce some of the emotional side effects of the condition.
Some individuals may choose to incorporate alternative therapies into their dementia treatment plan.
According to the Alzheimer’s Association, the following supplements have all been suggested for use in the treatment of dementia:
- coenzyme Q10
- coral calcium
- ginkgo biloba
- huperzine A
- omega-3 fatty acids
In some research studies, these supplements have been shown to decrease the severity of cognitive decline. However, there still isn’t enough evidence to suggest that these types of alternative therapies are effective for treating or preventing dementia.
- Dementia screening can be performed by your doctor or care team as part of your annual wellness exam.
- If you’re a Medicare beneficiary, you’re covered for this annual wellness exam and for a variety of other tests that can be used to diagnose dementia.
- For more information on which types of dementia tests are available to you under your Medicare plan, reach out to your doctor or plan provider directly.
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