Will Medicare Cover Alzheimer’s Brain Scans?

In the past few months, Julia has noticed that her mother, Betsy, has become increasingly forgetful. Betsy’s memory loss started out mild, including losing her keys and forgetting the day of the week, but is beginning to disrupt her daily life. She often gets confused and sometimes loses concept of place and time. She has gotten lost driving and has left the stove on before, nearly burning her house down. Julia is concerned about her mother’s forgetfulness and would like to get her tested for dementia as soon as possible.

Taking a Cognitive Assessment

Many people are tested for Alzheimer’s or other forms of dementia using a cognitive assessment, an evaluation tool that health care professionals use in the clinical setting to determine if an individual is experiencing cognitive decline or impairment. During a cognitive assessment, your loved one is given verbal and written assessments to evaluate cognitive functions including memory, visuospatial awareness, and language skills. These short assessments are not used to make a diagnosis, but rather to determine if more comprehensive testing/examination is needed.

The Alzheimer’s Association actually recommends that “anyone who has concerns about their thinking or memory ask their doctor or health provider for a cognitive assessment.” According to the association, cognitive tests are a “required component” of the Medicare annual wellness visit for any seniors over the age of 65 to establish a cognitive baseline so practitioners can compare responses from year to year. Assessments can also be conducted if family members report being concerned about a relative’s mental state.

What Comes After the Cognitive Assessment?

If health care professionals do suspect a problem following a cognitive test, the next step is usually to conduct more comprehensive tests. In some cases, the patient may be referred to a specialist, who can make an accurate diagnosis.

PET Scans to Diagnose Alzheimer’s Won’t Be Covered by Medicare

Positron Emission Tomography (PET) brain scans have been developed to detect signs of dementia in living patients. They are costly, at $4,000 to $5,000 a scan, and insurers, including Medicare, haven’t covered them in the past because it’s not known if they have benefits. Based on the results of a recent study, that doesn’t look like it’s going to change.

A high-profile $100 million study was recently conducted by the University of California, San Francisco to help Medicare officials decide whether to start covering PET scans to check for Alzheimer’s disease. Dr. Gil Rabinovici led the study and gave results at the Alzheimer’s Association International Conference late last month. They have not been published or reviewed by other scientists yet.

The study included more than 25,000 Medicare beneficiaries, with researchers exploring whether PET diagnosis could curb hospitalization costs. Hospitalizations and emergency room visits are typically high among people with dementia because their confusion may lead them to take too much or skip medicines, or to wake in the night and fall and break a bone. The theory: If a scan reveals someone has Alzheimer’s, caregivers can put a plan in place to prevent such problems.

The effort fell short of its goal of cutting hospitalizations by 10% in the first year following a scan, casting doubt on PET’s possible use in regular clinical care. Still, patients and families want an accurate diagnosis to make big life decisions such as moving, retiring, or redoing finances.

Dr. Howard Fillit, chief science officer of the Alzheimer’s Drug Discovery Foundation, which had no role in the study, sees value in the scans. “If it was any other disease, people would want a specific diagnosis” and the scans give that, he said. “But with a blood test on the horizon for diagnosing the disease, relying on scans may become a moot issue.”

A Promising Blood Test is On the Horizon for Alzheimer’s Diagnosis

Researchers are inching closer to a blood-based diagnostic test to detect Alzheimer’s disease before symptoms arise. An experimental blood test was highly accurate at distinguishing people with Alzheimer’s disease from those without it in several studies, boosting hopes that there soon may be a simple way to help diagnose this most common form of dementia.

The p-tau217 test outperformed many other measures for indicating which patients had Alzheimer’s as verified by brain scans. It also was comparable to the brain scans and some spinal tests in accuracy. The testing identified people with Alzheimer’s vs. no dementia or other types of it with accuracy ranging from 89% to 98%.

Researchers have been working for decades to develop an easy and affordable alternative that would spot people in the preclinical stages of the disease. The idea being, once drugs are available, these patients would never develop any symptoms of the memory-destroying affliction.

“This is just an exploratory study, but we think phosphorylated tau 217 is a promising target for an early diagnostic test,” according to researcher Nicolas Barthelemy. “There was a large difference between the amyloid-positive and amyloid-negative groups, even amongst people who were cognitively normal. Once we improve the way we are preparing and concentrating the sample, we will be a step closer to developing a tau-based blood test that can identify people at risk of developing Alzheimer’s dementia before symptoms arise.”

The Benefits of Early Detection

“Early detection of cognitive impairment offers several important benefits,” said Keith Fargo, the director of scientific programs and outreach for the Alzheimer’s Association. “It offers an opportunity to diagnose and potentially reverse treatable forms of cognitive decline. For cognitive conditions such as Alzheimer’s and other dementias, early detection and diagnosis enables access to symptomatic treatments, more time for critical care planning, better disease management, participation in clinical trials and an opportunity for diagnosed individuals to have a voice in their future care.” So, if you think you or a loved one has symptoms of Alzheimer’s or another form of dementia, it is wise to get tested as soon as possible.

Medicaid Planning for Alzheimer’s and Other Types of Dementia

Alzheimer’s disease is probably the worst health and social care challenge of our generation, and a diagnosis of the disease is life-changing. When it comes to legal planning for long-term care, generally the earlier someone with dementia plans, the better the result. But it is important to know that it’s never too late to begin the process of Long-term Care Planning, also called Lifecare Planning and Medicaid Asset Protection Planning. Medicaid planning can even be started by an adult child acting as agent under a properly-drafted Power of Attorney, and even if your loved one is already in a nursing home or receiving other long-term care services.

Medicaid Asset Protection

Do you have a loved one who is suffering from Alzheimer’s or any other type of dementia? Persons with dementia and their families have unique financial and legal issues. Here at the Farr Law Firm, we are dedicated to easing the financial, legal, and emotional burden on those suffering from dementia and their loved ones. We help protect your hard-earned assets while maintaining your comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veteran’s Aid and Attendance. As always, please feel free to call us for an initial consultation:

Fairfax Medicaid Planning: 703-691-1888
Fredericksburg Medicaid Planning: 540-479-1435
Rockville Medicaid Planning: 301-519-8041
DC Medicaid Planning: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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