Alzheimer’s disease and most other forms of dementia are progressive. As you or your loved one begin to experience greater memory loss and other dementia-related symptoms, you may need to consider a more supportive care environment. Unfortunately, memory care is costly – that’s why many people turn to long-term care insurance.
If you’re exploring your options, which may range from in-home care to skilled nursing in a facility, we’re here to help you understand your insurance options.
What Is Alzheimer’s Disease?
Alzheimer’s disease is the most common type of dementia – and the number of people with an Alzheimer’s diagnosis is growing every day. While we’re still learning a lot about the disease, researchers know that it gradually damages and kills brain cells. Common symptoms associated with Alzheimer’s include:
- Memory loss
- Problems with word-finding and communication
- Visual and spatial difficulties
- Poor judgment
- Mood swings and personality changes
- Mobility issues and muscle weakness
- Problems with self-care activities
Unfortunately, many people with Alzheimer’s are resistant to care and may even become combative when you mention their changing needs. However, most, if not all, people with the diagnosis will require skilled nursing care at some point in their journey.
Medicare Does Not Cover Long-Term Care for Alzheimer’s
While many people assume that Medicare will cover all the costs associated with Alzheimer’s and dementia care, they are sadly mistaken. However, it may cover some of the costs associated with your long-term care planning. Ask your provider about covered services that can help you understand your options for care and treatment in your community.
You should also build a legal and financial plan that protects you or your loved one as their Alzheimer’s disease advances. This may include an estate plan, powers of attorney, and insurance policies that cover your family’s needs.
When Does Alzheimer’s Disease Qualify for Long-Term Care Coverage?
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. However, if you or your loved one was proactive and obtained long-term care insurance earlier on, it may provide much-needed coverage for dementia care.
Most long-term care policies require that you have a medically diagnosed diagnosis of a chronic condition and that you are unable to perform essential activities of daily living (sometimes called ADLs). These activities include:
- Bathing, such as taking a shower or using a tub
- Dressing and grooming activities
- Toileting and personal hygiene needs
- Eating and drinking
- Safely moving in and out of bed and chairs
If your loved one cannot perform these core activities without significant assistance, they may qualify for long-term care coverage.
Why Did My Long-Term Care Insurer Deny My Claim?
Because Alzheimer’s disease typically impacts cognitive and emotional function before it limits a person’s physical abilities, long-term care insurers are sometimes skeptical of them. Unless you have clear data demonstrating your loved one’s deficits, you may face an unwanted denial. The company may even provide medical opinions from a consulting physician who reviewed a limited number of their medical records and never examined your loved one.
Other times, the insurance company may schedule an “independent medical examination” with an insurance company retained nurse, who will sometimes find limitations that are less severe than those identified by treating physicians and caregivers. Often the nurse will use the Mini-Mental State Exam (MMSE) created in 1975 by Marshal Folstein, MD. Others use the Montreal Cognitive Assessment (MoCA) which was created in 1996.
Both the MMSE and the MoCA are routine cognitive screening tests rated on a 30-point scale. They are both brief, though the MMSE is a little shorter, taking about seven to eight minutes to administer. The MoCA takes approximately 10 to 12 minutes. Neither test is very detail oriented and both would likely be used only for initial screening. “For mild impairment, the MoCA is the better test,” says Abhay Moghekar, MBBS, an assistant professor of neurology at The Johns Hopkins University School of Medicine in Baltimore. The MoCA test is considered more sensitive of the two.
Some insurance companies set a score that is unreasonably low to gauge cognitive impairment. The person’s educational, occupational and overall achievement in life requires adjusting scores up or down.
To fight back, you’ll need help from a skilled long-term care attorney who understands the nuances of Alzheimer’s disease and the complexities of long-term care insurance policies. We work closely with our clients and their providers, assessing their real abilities and needs. Then, we build compelling cases for long-term care coverage.
Does Long-Term Care Insurance Cover Alzheimer’s? Call for a Complimentary Consultation With Jonathan M. Feigenbaum, Esquire
At Jonathan M. Feigenbaum, Esquire, we’ve built a reputation for our exceptional representation in long-term care claims. We provide compassionate, aggressive, and practical legal services, focusing on getting our clients the care and financial security they need.
If you or a loved one were recently diagnosed with Alzheimer’s disease or another form of dementia, call our office today. We can help you understand all of your long-term care planning options and help you get the coverage you deserve.