Medicare alone is often **not enough to fully cover Alzheimer’s medications** due to the complexity of drug coverage and the high costs associated with these treatments. While Medicare Part D provides prescription drug coverage, it has limitations that can leave patients with significant out-of-pocket expenses, especially for costly Alzheimer’s drugs.
Alzheimer’s disease medications, such as cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and NMDA receptor antagonists (memantine), are typically covered under Medicare Part D, which is the prescription drug benefit. However, coverage depends on the specific Part D plan’s formulary—the list of drugs the plan agrees to cover. Each plan selects its formulary with some oversight from Medicare, but formularies vary widely, and not all Alzheimer’s medications may be included or may be subject to restrictions like prior authorization or step therapy. This means patients might face delays or denials before getting their medication covered.
Medicare Part D plans also involve **cost-sharing**: premiums, deductibles, copayments, and coinsurance. In 2025, the average monthly premium for Part D is around $46.50, and there is an out-of-pocket spending cap of $2,000 for medications. However, Alzheimer’s drugs can be expensive, and patients often reach this cap quickly, leading to substantial personal costs. Additionally, if a patient does not enroll in Part D when first eligible, they may face late enrollment penalties, increasing their costs further.
Medicare Part B, which covers outpatient medical services, generally does not cover outpatient prescription drugs like Alzheimer’s medications unless administered in a clinical setting (e.g., certain infusions). Therefore, Part B is usually not a source of coverage for these drugs.
Medicare Advantage (Part C) plans, offered by private insurers, combine Parts A, B, and usually D, and sometimes provide additional benefits. Recent changes have allowed some Medicare Advantage plans to offer **Special Supplemental Benefits for the Chronically Ill (SSBCI)**, which can include services that improve or maintain health for Alzheimer’s patients, such as home health care, transportation to medical appointments, or safety modifications at home. However, these benefits vary widely by plan and location, and not all plans cover Alzheimer’s medications fully or at low cost.
Another important aspect is **Medication Therapy Management (MTM)** programs required under Part D. These programs help patients with multiple chronic conditions, including Alzheimer’s, manage thei
