Does Medicare Pay for Alzheimer’s Testing?
Get clarity on Medicare coverage for Alzheimer's testing. Understand what services are covered, eligibility, and your costs.
Alzheimer’s disease impacts millions. Early detection and diagnosis offer benefits, including access to treatments that may slow progression and aid in future care planning. Understanding Medicare’s support for Alzheimer’s diagnostic efforts is valuable. This article outlines the specific testing services Medicare covers, the conditions for coverage, and potential costs beneficiaries may encounter.
Specific Medicare Covered Services for Alzheimer’s Testing
Medicare covers various services for detecting and diagnosing cognitive impairment. Cognitive assessments are integrated into routine preventive visits, such as the “Welcome to Medicare” preventive visit and annual wellness visits. These services are provided without cost to the beneficiary.
Should concerns arise during these initial assessments, Medicare Part B covers a separate, more comprehensive visit dedicated to reviewing cognitive function. This specialized evaluation aims to establish or confirm a diagnosis like dementia or Alzheimer’s disease and facilitate the development of a care plan. During this focused assessment, a healthcare provider may conduct a detailed history, perform a physical examination, and review medications. An independent historian, such as a family member or caregiver, may also provide valuable insights.
Beyond these assessments, Medicare Part B covers various diagnostic tests to determine the cause of cognitive decline. This includes medically necessary laboratory and other non-laboratory tests. Imaging scans are also covered to rule out other conditions causing dementia-like symptoms, such as strokes or tumors. Medicare now covers amyloid Positron Emission Tomography (PET) scans, which detect beta-amyloid plaques in the brain, a key marker of Alzheimer’s disease.
Conditions for Medicare Coverage
For Medicare to cover Alzheimer’s testing and related diagnostic services, certain conditions must be met, primarily centered on medical necessity. Services must be considered reasonable and necessary for the diagnosis or treatment of an illness or injury. This means a healthcare provider must suspect cognitive impairment or a specific medical condition, rather than simply conducting general screening for individuals without symptoms. While cognitive assessments are part of routine annual wellness visits, further diagnostic tests are typically initiated when a doctor observes signs of decline or receives reports of concern from the patient or their caregivers.
These diagnostic services are primarily covered under Medicare Part B, which is medical insurance for outpatient care. Part B covers doctor visits, laboratory tests, and imaging, including specialized cognitive assessments and care planning services. Medicare Part A, which provides hospital insurance, may cover some diagnostic services if performed during an inpatient hospital stay. Part A also covers up to 100 days in a skilled nursing facility for medically necessary skilled care, following a qualifying hospital admission.
Individuals enrolled in Medicare Advantage (Part C) plans receive their Medicare Part A and B benefits through a private insurance company. These plans are required to cover all services that Original Medicare covers, including those for Alzheimer’s testing. Medicare Advantage plans operate under their own specific rules for cost-sharing and network providers, which can vary by plan. Diagnostic tests must be ordered by a qualified healthcare provider who accepts Medicare.
Understanding Patient Costs
Even with Medicare coverage for Alzheimer’s testing, beneficiaries typically incur various out-of-pocket expenses. For services covered under Medicare Part B, which includes most diagnostic testing, a standard monthly premium applies, which is $185 in 2025. Additionally, beneficiaries must meet an annual Part B deductible, set at $257 for 2025, before Medicare begins to pay its share. After the deductible is satisfied, individuals are generally responsible for a 20% coinsurance of the Medicare-approved amount for most services.
For services covered under Medicare Part A, such as inpatient hospital stays for diagnostic purposes, a deductible of $1,676 per benefit period applies in 2025. This deductible can be incurred multiple times within a year if there are separate benefit periods. Coinsurance amounts also apply for extended hospital or skilled nursing facility stays. Unlike Medicare Advantage plans, Original Medicare (Parts A and B) does not have an annual out-of-pocket maximum.
Many beneficiaries choose to enroll in a Medicare Advantage plan or purchase a Medigap (Medicare Supplement Insurance) policy to help manage these costs. Medicare Advantage plans combine Part A and Part B coverage and often include prescription drug coverage, but they have their own deductibles, copayments, and coinsurance structures. These plans include an annual out-of-pocket maximum, which is $9,350 for in-network services in 2025. Medigap policies are sold by private companies and help cover the “gaps” in Original Medicare, such as deductibles and coinsurance, reducing a beneficiary’s out-of-pocket financial exposure. Medicare does not cover long-term custodial care; these expenses generally fall to the individual or other insurance.