0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Medical Insurance Coverage and Alzheimer Disease

Carol F. Lippa, MD1
[+] Author Affiliations
1Department of Neurology, Drexel University College of Medicine, Philadelphia, Pennsylvania
JAMA Neurol. 2015;72(11):1231. doi:10.1001/jamaneurol.2015.2147.
Text Size: A A A
Published online

Extract

This Viewpoint explores ways in which medical insurance coverage in the United States should better approach costs associated with Alzheimer disease.

Heart disease and cancer are the 2 leading causes of nonaccidental death in American individuals. Recent studies suggest that Alzheimer disease (AD) is underreported and ranks third.1 Today, more than 5 million Americans have AD.2 In 2010, the costs associated with AD and related dementias approached $215 billion.3 By 2050, that number is estimated to reach $1.2 trillion unless disease-modifying interventions are developed.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment
AAlzheimers Disease Update form New York
Posted on October 28, 2015
David HOffman
New York State Department of Health; UAlbany School of Public Health Department of Health Policy Management and Behavior
Conflict of Interest: None Declared
Response to Dr Carol Lippa: Medical Insurance Coverage and Alzheimer Disease; JAMA Neurol. 2015; :1-2. doi: 10.1001/jamaneurol.2015.2147



Dr. Lippa describes challenges of caring for people with Alzheimer’s disease or other dementias (AD/D). Policymakers are increasingly engaging on this issue on all levels. Significant improvements have occurred in recent years for families and patients with AD/D (1). Most of the 5 million people with dementia are age 65 or older (2) and eligible for Medicare and Social Security. Most are enrolled prior to onset; there is no special application process for AD/D. Medicare covers many AD/D diagnostic services, although requirements for pre-authorizations vary by Part B plan.
The focus and cost driver for caring for people with AD/D, is long-term services and supports (LTSS), assistance with everyday activities such as bathing, dressing, meals, or managing money. Individuals with AD/D need more of these services than other older adults (3). This care, far beyond custodial care, is mostly provided by family and friends estimated at 17.9 billion hours annually (4). When families use paid providers, costs are high: Home care, 8 hours/day costs an average of $58,400 annually (5).
Eligible families do have access to some assistance. Medicaid provides coverage for health care and LTSS for people with AD/D who have low income/ assets, or who “spend down” to eligibility. Protections exist for families, specifically for their homes and some assets. In all states, nursing home care is available to Medicaid recipients who need that level of care. Most state Medicaid programs covers home and community-based services (HCBS) including personal care by paraprofessionals, states may limit the number and type of beneficiaries eligible for these services, as well as the range of services provided, and thus may have waiting times. Some HCBS providers are available through the Aging Network (for information, see eldercarelocator.gov).
State action is called for too, under Governor Cuomo’s leadership, New York is now implementing the largest state initiative ever. This $25 million effort will expand a set of evidenced-based services to more people than ever before and we are also committed to evaluating and sharing results for future health policy development.
The National Advisory Council on Alzheimer’s Disease (6) annually makes recommendations to the HHS Secretary and Congress addressing AD/D. I’ve been honored to serve on this group for the past four years, chairing the LTSS Committee. Our recommendations include adequate reimbursement, specialized training, a lead agency in every state, support for caregivers, and increasing funding for LTSS (7). Council meetings are quarterly, webcast, and open, with time for public comments.
Not long ago, AD/D was hidden and barely recognized in policy. Through national efforts and leadership in many states, we are beginning to ease the burden on people with AD/D and their families. I encourage anyone interested in advancing this effort to reach out to their local Alzheimer’s Association, contact me, or submit a comment to the Advisory Council on Alzheimer’s Research, Care, and Services. While our research colleagues work to find a cure, we need providers, families and advocates to work to ensure that loved ones with dementia get the best care possible.

Author:
David Hoffman, Director, Bureau of Community Integration and Alzheimers Disease
New York State Department of Health, Office of Health Insurance Programs
Clinical Associate Professor, Department of Health Policy Management and Behavior
UAlbany School of Public Health
One Commerce Plaza, Suite 1605
Albany, New York 12210
David.hoffman@health.ny.gov
518-486-6722

References:
Hoffman, D. (2015). Looking At The Future of Alzheimer’s Disease Policy. Health Affairs Blog. Retrieved from http://healthaffairs.org/blog/2015/07/14/looking-at-the-future-of-alzheimers-disease-policy/.
2 An estimated 200,000 people in the United States have early-onset dementia, which begins before age 65. These people often have a difficult time getting Social Security Disability Insurance and subsequently Medicare coverage. The Affordable Care Act, but removing the ban on denials for pre-existing conditions, is expected to ensure that some of these patients have health insurance coverage.
3 Kasper, J.D., Freedman, V.A., Spillman, B.C. (2014). Disability and Care Needs of Older Americans by Dementia Status: Findings from the 2011 National Health and Aging Trends Study. Prepared for the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy, at Table 9. Retrieved from http://aspe.hhs.gov/daltcp/reports/2014/NHATS-DS.cfm.
4Alzheimer’s Association. 2015 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia. 2015; 11(3): 332+.
5 MetLife Mature Market Institute. (2012). Market Survey of Long-Term Care Costs. Retrieved from https://www.metlife.com/assets/cao/mmi/publications/studies/2012/studies/mmi-2012-market-survey-longterm-care-costs.pdf.
6 http://aspe.hhs.gov/national-alzheimers-project-act
7 http://aspe.hhs.gov/national-alzheimers-project-act#Advisory Council Recommendations

Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

514 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Care at the Close of Life: Evidence and Experience
Alzheimer Disease: "It's OK, Mama, If You Want to Go, It's OK"

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Supplemental Content

brightcove.createExperiences();