The guide to
Insurance & Financial Planning
Understanding coverage and benefits
Navigating insurance decisions over time
Planning for the cost of care
narration
Why planning early matters
A dementia diagnosis can reshape finances, insurance needs, and long-term planning.From diagnostic tests and medications to home care, respite services, and long-term care facilities, costs can add up quickly. Planning early gives families more options — and more control. Learn what insurance can cover, and what it doesn’t.
narration
What does insurance actually cover?
Insurance coverage for dementia care depends on the type of care — and the type of insurance.
Medicare
Medicaid
Private insurance
Coverage often changes as needs evolve — from diagnosis to advanced care.
narration
Understanding Medicare
What is Medicare?
Medicare generally starts for people at 65, and people sometimes buy additional insurance on top of Medicare. It does not cover long-term care and anything considered non-medical, such as paying people to stay with their loved-one to make sure they are safe or for support with general activities of daily living, even though this can be necessary for some people living with dementia.
People who are employed in the United States pay into Medicare during their working lives, and then pay an additional premium during retirement years.
narration
Understanding Medicaid
What is Medicaid?
“Medicaid is one of the only significant public sources of money that will help you with the long-term care costs associated with dementia. Medicaid benefits start when you can show you’re financially absolutely in need. It’s really intended to be a last resort for families who are paying for long-term care but there are some significant differences [from Medicare].”
Michael Guerrero Co-founder of Elder Care Resource Planning
narration
Paying for diagnosis and treatment
Getting an accurate diagnosis can be expensive — and coverage isn’t guaranteed.
New Alzheimer’s drugs, like Leqembi, are covered by Medicare and Medicaid under specific conditions because the drug is FDA-approved — but private insurers may deny coverage.
Amyloid PET scans may or may not be covered, depending on insurance and state policies.
State laws increasingly shape what diagnostic tests insurers must cover. Knowing what questions to ask — and how to appeal denials — matters.
narration
Planning for long-term care
Long-term care is one of the biggest financial challenges families face. Options include:
Home care, which may be partially covered by Medicaid or paid out-of-pocket
Assisted living, typically not covered by Medicare
Nursing homes, often paid for privately at first, then through Medicaid
Planning ahead can help families avoid financial challenges later.
narration
Read more
Should you consider long-term care insurance?
Long-term care insurance can help cover services Medicare doesn’t — but it’s not right for everyone. Consider:
For some families, financial planning tools beyond insurance may be a better fit. Consulting an elder law attorney is useful when navigating long-term care insurance.
narration
An expert’s perspective
Hear from Kim Natovitz, a financial planner at TriBridge Partners, about long-term care insurance.
Expert's perspective
“If you have a family member who has had Alzheimer’s or dementia, it’s especially important for you to begin your planning sooner rather than later. We all have priorities in terms of looking at our overall financial plan, but don’t let perfection be the enemy of good. Certainly having some long-term care insurance would be better than not having anything at all. Most people begin looking at long-term care insurance about a decade before they retire… There are some short-term care policies, which will provide benefits that will be for a year or less, that can be less expensive.”
Kim NatovitzAssociate at TriBridge Partners
Read more
narration
When one man’s insurance denied his Leqembi coverage
Dan Jaworski, an IRONMAN competitor, was diagnosed with early-onset Alzheimer’s disease at age 54. Since he is under 65, he doesn’t qualify for Medicare, which covers Kisunla as well as the associated amyloid PET brain scans. His private insurer, Florida Blue, denied him coverage.Jaworski qualified for a Kisunla trial at the K2 Research Center where he has access to the drug as part of the study. “It was very disappointing,” Jaworski said of his battle with his insurer. “I got lucky that I found the trial. You’ve got to be your own advocate.” Research participation can sometimes bridge coverage gaps.
narration
Insurance gaps and discrimination
Insurance systems don’t affect everyone equally.
- Some insurers can legally discriminate based on biomarkers, even before symptoms appear.
- Access to diagnostic testing and care often depends on ZIP code, income, and state policy.
- These gaps disproportionately affect underrepresented and marginalized communities.
Many people worry about the privacy concerns of genetic testing, and how a test confirming genetic risk of Alzheimer’s or another form of dementia could impact their insurance.
narration
Insurance gaps and discrimination
The US Genetic Information Non-Discrimination Act (GINA) helps but fails to protect against blood-based biomarkers, cerebral spinal fluid biomarkers, or neuroimaging, according to Stanford University Law professor Hank Greely.
“The act only deals with employment and health insurance, but it doesn’t deal with life insurance and probably most significantly for the Alzheimer’s community, it doesn’t deal with disability insurance or long-term care insurance.” Hank Greely Stanford University Law Professor
While many insurance providers don’t require people to disclose their genetic test results, insurers in theory could use this information to determine whether or not to provide long-term care coverage for a healthy individual and their family members in the future.
narration
Read more
End-of-life care and hospice decisions
Financial planning also includes preparing for end-of-life care. Hospice services can provide comfort-focused care, but dementia patients are unlikely to meet Medicare’s stringent criteria for hospice, which is designed to limit hospice to patients who are expected to die within six months. On top of this, Medicare’s criteria require that people with dementia require help with basic things like toileting and walking, and have a terminal complication of dementia such as aspiration pneumonia, recurrent UTIs, or bed sores. Medicare’s hospice benefits also do not provide hands-on care, meaning that family caregivers are still left with medication administration, hand-feeding, monitoring, and other things.
narration
Learn more
Understanding insurance coverage options and their financial implications won’t eliminate uncertainty — but it can help families face dementia with more clarity and fewer surprises. Explore more on beingpatient.com
narration
Want to keep learning?
Visit
beingpatient.com
for the latest news and information on brain health and Alzheimer's disease
narration
Private insurance coverage varies widely and may include prior authorizations or denials.
- A federal program run by individual states, and states have different levels and eligibility rules.
- The asset limit for an unmarried individual in most states is $2,000, although there are allowances for your home and car. There are also allowances for your spouse to hold on to a certain amount of cash separate from your home and car.
- Regulations regarding your tax-qualified retirement account vary by state
- Medicaid pays for your care indefinitely as long as you qualify financially. In general, it doesn’t pay for basic living expenses but it does pay for care and medical equipment in your home. Full care in a live-in facility can also be covered by Medicaid sometimes.
Medicare generally covers doctor visits, hospital stays, some diagnostic tests, and limited home health care.
Medicaid may cover long-term care services, including nursing homes and those based at home and in the community — but eligibility depends on income and assets.
Insurance & Financial Planning
Deborah Kan
Created on January 21, 2026
Start designing with a free template
Discover more than 1500 professional designs like these:
View
Explainer Video: Keys to Effective Communication
View
Explainer Video: AI for Companies
View
Corporate CV
View
Flow Presentation
View
Urban Illustrated Presentation
View
Geographical Challenge: Drag to the map
View
Decisions and Behaviors in the Workplace
Explore all templates
Transcript
The guide to
Insurance & Financial Planning
Understanding coverage and benefits
Navigating insurance decisions over time
Planning for the cost of care
narration
Why planning early matters
A dementia diagnosis can reshape finances, insurance needs, and long-term planning.From diagnostic tests and medications to home care, respite services, and long-term care facilities, costs can add up quickly. Planning early gives families more options — and more control. Learn what insurance can cover, and what it doesn’t.
narration
What does insurance actually cover?
Insurance coverage for dementia care depends on the type of care — and the type of insurance.
Medicare
Medicaid
Private insurance
Coverage often changes as needs evolve — from diagnosis to advanced care.
narration
Understanding Medicare
What is Medicare?
Medicare generally starts for people at 65, and people sometimes buy additional insurance on top of Medicare. It does not cover long-term care and anything considered non-medical, such as paying people to stay with their loved-one to make sure they are safe or for support with general activities of daily living, even though this can be necessary for some people living with dementia.
People who are employed in the United States pay into Medicare during their working lives, and then pay an additional premium during retirement years.
narration
Understanding Medicaid
What is Medicaid?
“Medicaid is one of the only significant public sources of money that will help you with the long-term care costs associated with dementia. Medicaid benefits start when you can show you’re financially absolutely in need. It’s really intended to be a last resort for families who are paying for long-term care but there are some significant differences [from Medicare].”
Michael Guerrero Co-founder of Elder Care Resource Planning
narration
Paying for diagnosis and treatment
Getting an accurate diagnosis can be expensive — and coverage isn’t guaranteed.
New Alzheimer’s drugs, like Leqembi, are covered by Medicare and Medicaid under specific conditions because the drug is FDA-approved — but private insurers may deny coverage.
Amyloid PET scans may or may not be covered, depending on insurance and state policies.
State laws increasingly shape what diagnostic tests insurers must cover. Knowing what questions to ask — and how to appeal denials — matters.
narration
Planning for long-term care
Long-term care is one of the biggest financial challenges families face. Options include:
Home care, which may be partially covered by Medicaid or paid out-of-pocket
Assisted living, typically not covered by Medicare
Nursing homes, often paid for privately at first, then through Medicaid
Planning ahead can help families avoid financial challenges later.
narration
Read more
Should you consider long-term care insurance?
Long-term care insurance can help cover services Medicare doesn’t — but it’s not right for everyone. Consider:
For some families, financial planning tools beyond insurance may be a better fit. Consulting an elder law attorney is useful when navigating long-term care insurance.
narration
An expert’s perspective
Hear from Kim Natovitz, a financial planner at TriBridge Partners, about long-term care insurance.
Expert's perspective
“If you have a family member who has had Alzheimer’s or dementia, it’s especially important for you to begin your planning sooner rather than later. We all have priorities in terms of looking at our overall financial plan, but don’t let perfection be the enemy of good. Certainly having some long-term care insurance would be better than not having anything at all. Most people begin looking at long-term care insurance about a decade before they retire… There are some short-term care policies, which will provide benefits that will be for a year or less, that can be less expensive.”
Kim NatovitzAssociate at TriBridge Partners
Read more
narration
When one man’s insurance denied his Leqembi coverage
Dan Jaworski, an IRONMAN competitor, was diagnosed with early-onset Alzheimer’s disease at age 54. Since he is under 65, he doesn’t qualify for Medicare, which covers Kisunla as well as the associated amyloid PET brain scans. His private insurer, Florida Blue, denied him coverage.Jaworski qualified for a Kisunla trial at the K2 Research Center where he has access to the drug as part of the study. “It was very disappointing,” Jaworski said of his battle with his insurer. “I got lucky that I found the trial. You’ve got to be your own advocate.” Research participation can sometimes bridge coverage gaps.
narration
Insurance gaps and discrimination
Insurance systems don’t affect everyone equally.
- Some insurers can legally discriminate based on biomarkers, even before symptoms appear.
- Access to diagnostic testing and care often depends on ZIP code, income, and state policy.
- These gaps disproportionately affect underrepresented and marginalized communities.
Many people worry about the privacy concerns of genetic testing, and how a test confirming genetic risk of Alzheimer’s or another form of dementia could impact their insurance.narration
Insurance gaps and discrimination
The US Genetic Information Non-Discrimination Act (GINA) helps but fails to protect against blood-based biomarkers, cerebral spinal fluid biomarkers, or neuroimaging, according to Stanford University Law professor Hank Greely.
“The act only deals with employment and health insurance, but it doesn’t deal with life insurance and probably most significantly for the Alzheimer’s community, it doesn’t deal with disability insurance or long-term care insurance.” Hank Greely Stanford University Law Professor
While many insurance providers don’t require people to disclose their genetic test results, insurers in theory could use this information to determine whether or not to provide long-term care coverage for a healthy individual and their family members in the future.
narration
Read more
End-of-life care and hospice decisions
Financial planning also includes preparing for end-of-life care. Hospice services can provide comfort-focused care, but dementia patients are unlikely to meet Medicare’s stringent criteria for hospice, which is designed to limit hospice to patients who are expected to die within six months. On top of this, Medicare’s criteria require that people with dementia require help with basic things like toileting and walking, and have a terminal complication of dementia such as aspiration pneumonia, recurrent UTIs, or bed sores. Medicare’s hospice benefits also do not provide hands-on care, meaning that family caregivers are still left with medication administration, hand-feeding, monitoring, and other things.
narration
Learn more
Understanding insurance coverage options and their financial implications won’t eliminate uncertainty — but it can help families face dementia with more clarity and fewer surprises. Explore more on beingpatient.com
narration
Want to keep learning?
Visit
beingpatient.com
for the latest news and information on brain health and Alzheimer's disease
narration
Private insurance coverage varies widely and may include prior authorizations or denials.
Medicare generally covers doctor visits, hospital stays, some diagnostic tests, and limited home health care.
Medicaid may cover long-term care services, including nursing homes and those based at home and in the community — but eligibility depends on income and assets.