Several provisions of the Patient Protection and Affordable Care Act—the health care reform legislation signed into law by President Obama on March 23, 2010—will help individuals with Alzheimer's disease and other dementias, as well as their caregivers. Learn about them here. Please note that various parts of the health care reform law will be implemented at various times over the next few years. This page will be updated regularly as more information on specific provisions becomes available.
Consumer health insurance website
The Department of Health and Human Services has launched a new, easy-to-navigate website — English and Spanish — to help individuals find what health insurance options are available in their communities.
Medicare and the health care reform law
Drug rebates for seniors
At a certain point under the Medicare prescription drug program – a point known as the "coverage gap" or "donut hole" – Medicare stops paying part of the costs of a senior's prescription drugs, requiring seniors to pay the full cost themselves. This gap will be phased out by 2020.
Detection of possible cognitive impairment under Medicare
The health care reform law created a new Medicare benefit to provide an Annual Wellness Visit for every Medicare beneficiary. Regulations proposed on July 13 require that this Annual Wellness Visit includes detection of cognitive impairment. If the proposal is finalized, beginning January 1, 2011, for the first time, there would be a Medicare preventive service benefit for the detection of possible cognitive impairment.
This would increase the likelihood of early detection of cognitive impairment, thereby increasing the rate of diagnosis and allowing patients and families to plan their care at an earlier stage. The Alzheimer’s Association submitted comments in support of this regulation.
A new Medicare transitional care pilot project will provide services to seniors at a high risk of reentering the hospital. Those with cognitive impairment are specifically included in the pilot project.
Individuals with Alzheimer's often have one or more other chronic medical conditions. As a result, care coordination – effective communication among medical and community care providers and connecting an Alzheimer's patient and his/her family with the services they need – is crucial to providing better medical care and to increasing the opportunity to remain at home. On this front, the final health care bill:
- Establishes an "Innovation Center" at the Centers for Medicare and Medicaid Services (CMS) to test various ways to promote care coordination in the Medicare program, with language specifically encouraging CMS to test care coordination models that include people with cognitive impairment and dementia;
- Creates an "Independence at Home" pilot project to provide high-cost Medicare beneficiaries, including those with Alzheimer's, with coordinated, primary care services in lower-cost settings, rather than more expensive institutional settings;
- Allows groups of health care providers who join together to provide care for Medicare patients to share in any cost-savings they would achieve by being more efficient and cost-effective, provided that these "Accountable Care Organizations" coordinate care for those with multiple chronic conditions; and
- Provides private HMOs that participate in the "Medicare Advantage" program with a bonus payment for undertaking care coordination among seniors enrolled in their plans.
Home- and community-based services
Federal Medicaid payments will increase for those states that provide home- and community-based services to individuals who are otherwise eligible for nursing home care. This will encourage more states to provide – or to continue to provide – care for seniors with Alzheimer's in their homes and communities, rather than only through nursing homes.
A new voluntary insurance program will help people who are unable to perform two or more functional activities of daily living pay for nonmedical services and supports – to help them remain within their homes and communities for as long as they can. Individuals pay premiums while they are working and then are eligible for cash benefits if they become functionally impaired. Eligibility for the cash payments specifically includes people who develop substantial cognitive impairment. Benefits can be used to pay for such things as home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, and home care aides.
Insurance for individuals with early onset/younger onset Alzheimer's
Previously, it has been difficult for individuals with early onset (also known as younger onset) Alzheimer's disease – those younger than age 65 – to get and keeping private health insurance. The federal government will now provide premium subsidies to low- and moderate income individuals to help them purchase insurance as well as subsidies to businesses that provide health insurance coverage to retirees aged 55 to 64. More important, insurance companies will be required to:
- Issue insurance to all individuals who want to purchase it, thus ending pre-existing condition exclusions;
- Renew the policy to any enrolled individual wishing to renew;
- Maintain insurance for individuals who pay their premiums, thus ending the practice of rescinding the insurance coverage of high-cost individuals; and
- Limit the premiums charged to older individuals to no more than three times the amount charged to younger individuals.
These new insurance rules take effect in 2014. In the interim, the health care reform law established Pre-existing Condition Insurance Plans in every state for those who cannot get health insurance because of a pre-existing condition.
Fact sheet: Pre-existing Condition Insurance Plans – Frequently Asked Questions (PDF)
As of July 1, in states where the program is administered by the federal government (see Fact Sheet for a list of those states), you do not need a denial letter from an insurance company to prove the existence of a pre-existing condition. Instead, a doctor, physician assistant or nurse practitioner can provide a letter stating that you have or had a medical condition, disability or illness within the last 12 months. Below is a sample letter developed by the Centers for Medicare and Medicaid Services (CMS) for this purpose. Simply take it with you to your doctor.
Sample Physician Letter to Certify the Existence of a Pre-existing Condition (Word Doc)
Quality of care
Skilled nursing facilities and nursing homes will now be required to provide dementia management training for nurse aides. In addition, training and certification programs will be developed for home care aides to ensure they know how best to provide for an individual's needs, including the needs of those individuals with dementia. Finally, funding will be provided for dental training programs, including programs that teach oral health care for people with cognitive impairment.
For many diseases, expert panels of doctors and scientists have established quality care indicators – best medical practices for treating and caring for someone with a particular disease. Alzheimer's disease is not one of those conditions. The Department of Health and Human Services will now identify the diseases and conditions for which there are no quality care indicators and will then develop indicators for those conditions.
Family caregiver assistance
Education and training grants will be provided to Geriatric Education Centers. To receive the federal funding, these Centers must offer at least two free or nominal-cost courses a year to family caregivers, including instruction on managing the psychological and behavioral aspects of dementia.
A new medical research program – the Cures Acceleration Network – will focus on developing treatments and cures for high-need diseases. Currently, many laboratory discoveries never make it to market; that is, no treatments or medications are ever developed. The Cures Acceleration Network will emphasize funding research that bridges the gap between laboratory discoveries and actual treatments so that more patients can benefit from discoveries made in the lab.
Detection of possible cognitive impairment under Medicare
The health care reform law created a new Medicare benefit to provide an Annual Wellness Visit for every Medicare beneficiary. Regulations proposed on July 13 require that this Annual Wellness Visit includes detection of cognitive impairment. If the proposal is finalized,